Blurring lines between treatment intensity and patient fitness in elderly people with AML
Mené sur 118 patients atteints d'une leucémie myéloïde aiguë et âgés de plus de 60 ans, cet essai de phase II évalue l'efficacité, du point de vue de la survie sans maladie, et la toxicité d'un traitement de première ligne à base de cladribine utilisée en combinaison avec de faibles doses de cytarabine, en alternance avec la décitabine
The simplistic view in the onco-haematology field dichotomises the elderly patient population (ie, those aged ≥60 years) into two groups: the fit and the unfit for intensive treatment. Fitness—or rather, so-called unfitness—is defined on the basis of a combination of factors that have been associated with poor outcomes after intensive chemotherapy. These parameters are heterogeneous and relate to the biology of acute myeloid leukaemia (AML) but also to patient-related factors, such as comorbidities, performance status, or functional reserves, which are evaluated using more or less sophisticated tools. These factors were identified retrospectively, using data from population-based studies with series of patients who had been treated intensively, who represent less than 50% of all elderly patients with AML. Another problem is that these parameters confound prediction of toxicity and efficacy. In the era of classical chemotherapy, when toxicity and efficacy were closely linked, the composite definition of fitness formed on the basis of patient-related factors (associated with toxicity) and disease-related factors (associated with efficacy) made sense, but this is changing as leukaemia therapies advance.