老年急性髓系白血病的治疗进展

Advances in Treatment of Acute Myeloid Leukemia in the Elderly

老年急性髓系白血病(AML)患者治疗耐受性差,预后不佳。对于一般情况较好、无严重脏器合并症的老年AML患者,标准诱导缓解化疗方案优于小剂量化疗方案及支持治疗方案。对于接受巩固维持治疗的患者,小剂量化疗方案优于强化疗方案。具有高危核型的患者不适合接受强化疗,老年患者可依据细胞遗传学结果指导个体化治疗。吉姆单抗适用于不能耐受标准化疗的老年AML患者。有些患者可从降低强度预处理的异基因干细胞移植获益。

Elderly patients with acute myeloid leukemia （AML） tolerate intensive chemotherapy poorly and usually have poor prognosis. For elderly patients in good physical condition and without severe dysfunction of major organs, standard intensive induction chemotherapy is superior to non-intensive treatment or best supportive care alone. However, low-dose chemotherapy as post-remission treatment has more advantages than intensive chemotherapy. Intensive chemotherapy is not suitable for patients with unfavorable karyotypes, and genetic analysis is needed for individualized therapy regimen. Gemtuzumab ozogamicin may improve the survival of elderly patients who are intolerant to standard chemotherapy. Some patients may benefit from the transplantation of allogeneic stem cells after reduced-intensity conditioning.