Abstract
Approximately one third of patients diagnosed with acute promyelocytic leukemia (APL)
are above the age of sixty. It is important to ensure older adults receive optimal
diagnosis and management since this subtype of acute myeloid leukemia – given appropriate
treatment – is highly curable with lower risk of adverse events compared to other
types of leukemia. Historically, older age has been a risk factor for early death
and poorer overall survival. However, prospects have changed with the introduction
of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). APL is curable in the
majority of patients regardless of age, and the threshold of fitness that makes ATRA/ATO
therapy possible is likely to be lower than for cytotoxic chemotherapy. APL frequently
presents as a medical emergency and rapid diagnosis and intervention – typically involving
referral to a specialist centre – is a major determinant of outcome. After diagnosis,
management of APL in older adults presents particular challenges. Geriatric assessment,
including evaluation of frailty, comorbidities and polypharmacy can assist in providing
optimal supportive care for older adults during remission induction and may help individualize
therapy in the post-remission phase. Here, we review the available evidence, highlighting
areas of consensus, gaps in evidence and opportunities for research to enhance diagnosis,
management and survivorship for older patients.
Keywords
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Article info
Publication history
Published online: April 06, 2020
Accepted:
March 30,
2020
Received in revised form:
January 15,
2020
Received:
October 23,
2019
Identification
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