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Advances in the Management of Acute Myeloid Leukemia in Older Adult Patients

Barbara B. Rogers

acute myeloid leukemia, leukemia, geriatric nursing
ONF 2010, 37(3), E168-E179. DOI: 10.1188/10.ONF.E168-E179

Purpose/Objectives: To update oncology nurses on new developments in the care of older adult patients with acute myeloid leukemia (AML).

Data Sources: Clinical trial data, published guidelines, review articles, and conference proceedings.

Data Synthesis: Therapies for older adult patients with AML include cytarabine-based intensive-induction chemotherapy, investigational therapy, and supportive care. Nonmyeloablative allogeneic hematopoietic stem cell transplantation may provide the best opportunity for cure following remission if a human leukocyte antigen-matched hematopoietic stem cell donor is available. Careful assessment of patient- and disease-related factors is critical in determining the appropriate treatment modality for individuals. Assessment tools and algorithms may identify patients likely to be intolerant of intensive therapies. Supportive care may improve treatment tolerance and quality of life.

Conclusions: Survival outcomes have not improved significantly for older adult patients with AML. Novel therapies, coupled with better understanding of prognostic factors, may allow more highly individualized care. Performance status or comorbidity score may provide insights regarding outcome, particularly when combined with age, cytogenetic risk, or molecular markers. Efforts to improve transplantation safety may increase use in the older adult patient population.

Implications for Nursing: Nurses provide disease and treatment information, manage adverse effects, and offer emotional support. Knowledge of the key management issues for older adult patients with AML is critical in fulfilling this role.

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    References

    American Cancer Society. (2009). Cancer facts and figures 2009. Retrieved from http://www.cancer.org/downloads/STT/500809web.pdf
    Appelbaum, F. R., Gundacker, H., Head, D. R., Slovak, M. L., Willman, C. L., Godwin, J. E., … Petersdorf, S. H. (2006). Age and acute myeloid leukemia. Blood, 107, 3481-3485. doi: 10.1182/blood-2005-09-3724
    Aribi, A., Ravandi, F., & Giles, F. (2006). Novel agents in acute myeloid leukemia. Cancer Journal, 12, 77-91.
    Bennett, J. M., Catovsky, D., Daniel, M. T., Flandrin, G., Galton, D. A., Gralnick, H. R., & Sultan, C. (1985). Proposed revised criteria for the classification of acute myeloid leukemia. The French-American-British Cooperative Group. Annals of Internal Medicine, 103, 620-625.
    Buchner, T., Berdel, W. E., Wormann, B., Schoch, C., Haferlach, T., Schnittger, S., … Hiddemann, W. (2005). Treatment of older patients with AML. Critical Reviews in Oncology/Hematology, 56, 247-259. doi: 10.1016/j.critrevonc.2004.09.010
    Burnett, A. K., & Mohite, U. (2006). Treatment of older patients with acute myeloid leukemia—New agents. Seminars in Hematology, 43, 96-106. doi: 10.1053/j.seminhematol.2006.01.003
    Byrd, J. C., Mrozek, K., Dodge, R. K., Carroll, A. J., Edwards, C. G., Arthur, D. C., … Cancer and Leukemia Group B (CALGB 8461). (2002). Pretreatment cytogenetic abnormalities are predictive of induction success, cumulative incidence of relapse, and overall survival in adult patients with de novo acute myeloid leukemia: Results from Cancer and Leukemia Group B (CALGB 8461). Blood, 100, 4325-4336.
    Cashen, A., Schiller, G., Larsen, J., Cullen, M. T., DiPersio, J. F. (2006). Phase II study of low-dose decitabine for the front-line treatment of older patients with acute myeloid leukemia (AML). ASH Annual Meeting Abstracts, 108, 1984.
    de la Serna, J., Montesinos, P., Vellenga, E., Rayón, C., Parody, R., León, A, … Sanz, M. A. (2008). Causes and prognostic factors of remission induction failure in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and idarubicin. Blood, 111, 3395-3402. doi: 10.1182/blood-2007-07-100669
    Deschler, B., & Lubbert, M. (2006). Acute myeloid leukemia: Epidemiology and etiology. Cancer, 107, 2099-2107. doi: 10.1002/cncr.22233
    Döhner, K., & Döhner, H. (2008). Molecular characterization of acute myeloid leukemia. Haematologica, 93, 976-982. doi: 10.3324/haematol.13345
    Epstein, J. B., & Schubert, M. M. (1999). Oral mucositis in myelosuppressive cancer therapy. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 88, 273-276. doi: 10.1016/S1079-2104(99)70026-0
    Estey, E. (2006). General approach to and perspectives on clinical research in older patients with newly diagnosed acute myeloid leukemia. Seminars in Hematology, 43, 89-95. doi: 10.1053/j.seminhematol.2006.01.002
    Estey, E. (2007). Acute myeloid leukemia and myelodysplastic syndromes in older patients. Journal of Clinical Oncology, 25, 1908-1915. doi: 10.1200/JCO.2006.10.2731
    Estey, E., & Döhner, H. (2006). Acute myeloid leukemia. Lancet, 368, 1894-1907. doi: 10.1016/S0140-6736(06)69780-8
    Farag, S. S., Archer, K. J., Mrozek, K., Ruppert, A. S., Carroll, A. J., Cardiman, J. W., … Bloomfield, C. D. (2006). Pretreatment cytogenetics add to other prognostic factors predicting complete remission and long-term outcome in patients 60 years of age or older with acute myeloid leukemia: Results from Cancer and Leukemia Group B 8461. Blood, 108, 63-73. doi: 10.1182/blood-2005-11-4354
    Geller, R. B. (1996). Use of cytokines in the treatment of acute myelocytic leukemia: A critical review. Journal of Clinical Oncology, 14, 1371-1382.
    Giles, F. J., Kantarjian, H. M., Kornblau, S. M., Thomas, D. A., Garci-Manero, G., Waddelow, T. A., … Estey, E. H. (2001). Mylotarg (gemtuzumab ozogamicin) therapy is associated with hepatic venoocclusive disease in patients who have not received stem cell transplantation. Cancer, 92, 406-413. doi: 10.1002/1097-0142(20010715)92:2<406::AID-CNCR1336>3.0.CO;2-U
    Greiner, J., Döhner, H., & Schmitt, M. (2006). Cancer vaccines for patients with acute myeloid leukemia—Definition of leukemia-associated antigens and current clinical protocols targeting these antigens. Haematologica, 91, 1653-1661.
    Grimwade, D., Walker, H., Harrison, G., Oliver, F., Chatters, S., Harrison, C. J., … Medical Research Council Adult Leukemia Working Party. (2001). The predictive value of hierarchical cytogenetic classification in older adults with acute myeloid leukemia: Analysis of 1065 patients entered into the United Kingdom Medical Research Council AML11 trial. Blood, 98, 1312-1320. doi: 10.1182/blood.V98.5.1312
    Harris, D. J., Eilers, J., Harriman, A., Cashavelly, B. J., & Maxwell, C. (2008). Putting Evidence Into Practice: Evidence-based interventions for the management of oral mucositis. Clinical Journal of Oncology Nursing, 12, 141-152. doi: 10.1188/08.CJON.141-152
    Harris, D. J., & Knobf, M. T. (2004). Assessing and managing chemotherapy-induced mucositis pain. Clinical Journal of Oncology Nursing, 8, 622-627. doi: 10.1188/04.CJON.622-628
    Harris, N., Jaffe, E., Diebold, J., Flandrin, G., Muller-Hermelink, H. K., Vardiman, J., … Bloomfield, C. D. (1999). World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. Journal of Clinical Oncology, 17, 3835-3849. Retrieved from http://jco.ascopubs.org/cgi/content/full/17/12/3835 http://jco.ascopubs.org/cgi/content/full/17/12/3835
    Higa, G. M., Gockerman, J. P., Hunt, A. L., Jones, M. R., & Horne, B. J. (1991). The use of prophylactic eye drops during high-dose cytosine arabinoside. Cancer, 68, 1691-1693.
    Jabbour, E. J., Estey, E., & Kantarjian, H. M. (2006). Adult acute myeloid leukemia. Mayo Clinic Proceedings, 81, 247-260. doi: 10.4065/81.2.247
    Jackson, G. H., & Taylor, P. R. A. (2002). Acute myeloid leukaemia: Optimising treatment in elderly patients. Drugs and Aging, 19, 571-581. doi: 10.2165/00002512-200219080-00003
    Kantarjian, H., O'Brien, S., Cortes, J., Giles, F., Faderl, S., Jabbour, E., … Estey, E. (2006). Results of intensive chemotherapy in 998 patients age 65 or older with acute myeloid leukemia or high-risk myelo-dysplastic syndrome: Predictive prognostic models for outcome. Cancer, 106, 1090-1098. doi: 10.1002/cncr.21723
    King, M., & Rowe, J. (2007). Recent developments in acute myelogenous leukemia therapy. Oncologist, 12(Suppl. 2), 14-21.
    Kottaridis, P. D., Gale, R. E., Frew, M. E., Harrison, G., Langabeer, S. E., Belton, A. A., … Linch, D. C. (2001). The presence of a FLT3 internal tandem duplication in patients with acute myeloid leukemia (AML) adds important prognostic information to cytogenetic risk group and response to the first cycle of chemotherapy: Analysis of 854 patients from the United Kingdom Medical Research Council AML 10 and 12 trials. Blood, 98, 1752-1759.
    Leith, C. P., Kopecky, K. J., Chen, I. M., Eijdems, L., Slovak, M. L., McConnell, T. S., … Willman, C. L. (1999). Frequency and clinical significance of the expression of the multidrug resistance proteins MDR1/P-glycoprotein, MRP1, and LRP in acute myeloid leukemia. A Southwest Oncology Group study. Blood, 94, 1086-1099.
    Lowenberg, B., Boogaerts, M., Daenen, S., Verhoef, G. E., Hagenbeek, A., Vellenga, E., … van Putten, W. L. (1997). Value of different modalities of granulocyte-macrophage colony-stimulating factor applied during and after induction therapy of acute myeloid leukemia. Journal of Clinical Oncology, 15, 3496-3506.
    Lowenberg, B., Suciu, S., Archimbaud, E., Ossenkoppele, G., Verhoef, G. E., Vellegna, E., … Zittoun, R. (1997). Use of recombinant GMCSF during and after remission induction chemotherapy in patients aged 61 years and older with acute myeloid leukemia: Final report of AML-11, a phase III randomized study of the Leukemia Cooperative Group of European Organisation for the Research and Treatment of Cancer and the Dutch-Belgian Hemato-Oncology Cooperative Group. Blood, 90, 2952-2961.
    Lubbert, M., Rüter, B., Claus, R., Schmid, M., Germing U., & Eimermacher, H. (2007). Continued low-dose decitabine is an active first line treatment in all cytogenetic subgroups of older AML patients: Results of the FR00331 multicenter phase II study [Abstract]. Blood, 110, 300.
    Markovic, A., MacKenzie, K. L., & Lock, R. B. (2005). FLT-3: A new focus in the understanding of acute leukemia. International Journal of Biochemistry and Cell Biology, 37, 1168-1172. doi: 10.1016/j.biocel.2004.12.005
    Mayer, R., Davis, R., Schiffer, C., Berg, D. T., Powell, B. L., Schulman, P., … Frei, E., III. (1994). Intensive postremission chemotherapy in adults with acute myeloid leukemia. New England Journal of Medicine, 331, 896-903. doi: 10.1056/NEJM199410063311402
    Melchert, M. (2006). Managing acute myeloid leukemia in the elderly. Oncology, 20, 1674-1682.
    Mrózek, K., Marcucci, G., Paschka, P., Whitman, S. P., & Bloomfield, C. D. (2007). Clinical relevance of mutations and gene-expression changes in adult acute myeloid leukemia with normal cytogenetics: Are we ready for a prognostically prioritized molecular classification? Blood, 109, 431-448. doi: 10.1182/blood-2006-06-001149
    National Cancer Institute. (2008a). Search for clinical trials. Retrieved from http://www.cancer.gov/clinicaltrials/search
    National Cancer Institute. (2008b). Surveillance Epidemiology and End Results. Cancer statistics: AML. Retrieved from http://www.seer.cancer.gov/statfacts/html/amyl.html?statfacts_page=amyl.html&x=18&y=18
    National Comprehensive Cancer Network. (2009). NCCN Practice Guidelines in Oncology™: Acute myeloid leukemia [v.2.2010]. Retrieved from http://www.nccn.org/professionals/physician_gls/PDF/aml.pdf
    Ohno, R., Naoe, T., Kanamaru, A., Yoshida, M., Hiraoka, A., Kobayashi, T., … Saito, Y. (1994). A double-blind controlled study of granulocyte- stimulating factor started two days before induction chemotherapy in refractory acute myeloid leukemia: Kohseisho Leukemia Study Group. Blood, 83, 2086-2092. Retrieved from http://bloodjournal.hematologylibrary.org/cgi/reprint/83/8/2086 http://bloodjournal.hematologylibrary.org/cgi/reprint/83/8/2086
    Pinto, A., Zagonel, V., & Ferrara, F. (2001). Acute myeloid leukemia in the elderly: Biology and therapeutic strategies. Critical Reviews in Oncology/Hematology, 39, 275-287. doi: 10.1016/S1040-8428(00)00122-0
    Redaelli, A., Stephens, J. M., Brandt, S., Botteman, M. F., & Pashos, C. L. (2004). Short- and long-term effects of acute myeloid leukemia on patient health-related quality of life. Cancer Treatment Reviews, 30, 103-117. doi: 10.1016/S0305-7372(03)00142-7
    Sanz, M., Tallman, M., & Lo-Coco, F. (2005). Practice points, consensus, and controversial issues in the management of patients with newly diagnosed acute promyelocytic leukemia. Oncologist, 10, 806-814. doi: 10.1634/theoncologist.10-10-806
    Sekeres, M. A. (2006). Non-transplant therapy for older adults with acute myeloid leukemia. Journal of the National Comprehensive Cancer Network, 4, 51-56.
    Sekeres, M. A., & Stone, R. M. (2002). The challenge of acute myeloid leukemia in older patients. Current Opinion in Oncology, 14, 24-30. doi: 10.1097/00001622-200201000-00005
    Sekeres, M. A., Stone, R. M., Zahrieh, D., Morrison, V., DeAngelo, D. J., Galinsky, I., & Lee, S. J. (2004). Decision-making and quality of life in older adults with AML or advanced MDS. Leukemia, 18, 809-816. doi: 10.1038/sj.leu.2403289
    Simpson, J. K., & Rosenzweig, M. Q. (2002). Treatment considerations for the elderly person with cancer. AACN Clinical Issues, 13, 43-60. doi: 10.1097/00044067-200202000-00006
    Stock, W. (2006). Controversies in treatment of AML: Case-based discussion. Hematology, 185-191.
    Stone, R. M. (2002). The difficult problem of acute myeloid leukemia in the older adult. CA: A Cancer Journal for Clinicians, 52, 363-371. doi: 10.3322/canjclin.52.6.363
    Sudan, N., Rossetti, J. M., Shadduck, R. K., Latsco, J., Lech, J. A., Kaplan, R. B., … Lister, J. (2006). Treatment of acute myelogenous leukemia with azacitidine. Cancer, 107, 1839-1843. doi: 10.1002/cncr.22204
    Yancik, R. (1997). Cancer burden in the aged: An epidemiologic and demographic overview. Cancer, 80, 1271-1283.
    Zitella, L., Gobel, B., & O'Leary, C. (2009). Prevention of infection. In L. Eaton & J. Tipton (Eds.), Putting Evidence Into Practice: Improving oncology patient outcomes (pp. 267-283). Pittsburgh, PA: Oncology Nursing Society.
    Zittoun, R., Suciu, S., Mandelli, F., de White, T., Thaler, J., Stryckmans, P., … Willemze, R. (1996). Granulocyte-macrophage colony-stimulating factor associated with induction treatment of acute myelogenous leukemia: A randomized trial by the European Organization for Research and Treatment of Cancer Leukemia Cooperative Group. Journal of Clinical Oncology, 14, 2150-2159.