고령 급성골수성백혈병 환자에서의 조혈모세포이식

Hematopoietic Stem Cell Transplantation in Elderly Patients with Acute Myeloid Leukemia

Acute myeloid leukemia (AML) is predominantly a disease of the elderly, with a median age of over 65 years at diagnosis. AML treatment has significant difficulties in the elderly, who more often have poor cytogenetic and molecular risks, comorbidities and compromised performance status. Current therapeutic options for elderly AML patients include intensive chemotherapy with a cytarabine and anthracycline backbone, hypomethylating agents (decitabine and azacitidine), low-dose cytarabine, investigational agents, and supportive care with hydroxyurea and transfusions. Although encouraging complete remission (CR) rates, median survival remains short in elderly AML patients. Even patients who achieve CR present limited long-term survival without allogenic hematopoietic stem cell transplantation (allo-HSCT). Allo-HSCT is feasible and can provide improved survival in appropriately selected patients. Although increased age is associated with poorer survival, higher comorbidities and poorer performance status have more negative impact than age itself. The short duration of CR needs that leukemia and transplant physicians collaborate immediately after diagnosis to move quickly toward allo-HSCT. This collaboration is also important to choose the fit individuals to transplant and to bridge post-remission therapy (intermediate-dose cytarabine, hypomethylating agents or FLT3 inhibitors) in the unfit patients. Risks and benefits of each treatment option, especially allo-HSCT, are discussed here.