Estimate of overall treatment results in acute nonlymphocytic leukemia based on age-specific rates of incidence and of complete remission.

Abstract

It is widely assumed that most patients with acute nonlymphocytic leukemia (ANLL) are less than 60 years old, that greater than 50% of all patients can now achieve a complete remission (CR), and that bone marrow transplantation (BMT) represents a significant therapeutic breakthrough in this disease. New epidemiological data, presented in this study, show that the median age of patients with ANLL is 62-64 years, with 54%-59% of the patients being greater than 60 years old. When combining age-specific incidence data with age-specific data on CR derived from the recent literature, it can be calculated that the cumulated rate of CR for all ages combined will be only between 35.3% and 49.2% with current therapy. It can also be calculated that BMT with its present limitations can at most cure 1.44%-2.5% of all patients with ANLL. These findings suggest that some of the accepted conceptions in ANLL regarding age distribution of patients, cumulated rates of CR, and value of BMT cannot stand up to closer scrutiny. Treatment priorities and resource allocation in ANLL should be reconsidered, and more attention should be given to solving the problems of treatment in elderly patients.