The different therapeutic options that may be employed in the treatment of elderly patients with acute
leukemias and myelodysplastic states are considered following an analysis of certain
biological features, that have been investigated by cytochemical, cytogenetic and cytokinetic techniques, immunophenotyping, and studies on G-6-PD
isoenzymes. These studies imply that in the elderly the pattern of
hematological malignancies and the lack of response to conventional treatment derive from intrinsic
biological differences between these pathological states in older and younger patients. Treatment in elderly patients has ranged from
palliative treatment to intensive
chemotherapy, often with disappointing results in both cases.
Palliative treatment does not induce remissions, and median survival is short. On the other hand, elderly patients do not tolerate well both induction and post-remission
therapy due to the degree of toxicity and the effects of
drug-induced
pancytopenia. In this scenario, in vitro
drug-sensitivity testing and karyotyping assume increasing importance, because they may predict which patients are likely to benefit from intensive
therapy. In both acute
leukemias and myelodysplasias, treatment ideally should be designed case by case, according to the hematological, clinical and
biological features.