Mikkael A Sekeres

Statistically, it is probably no accident that the first reported case of leukemia (by Velpeau in 18271) occurred in a 63-year old. Acute myeloid leukemia (AML) is a disease of older adults. In the United States, the median age is 68 years and the age-adjusted population incidence is 17.6 per 100,000 for people 65 years of age or older.2 Compare this to an incidence of 1.8 per 100,000 for people under the age of 65 years.2 Therefore, of the estimated 11,900 new AML diagnoses in the United States in 2004, over half will affect patients 60 years of age or older,3 a population considered "elderly" in the leukemia literature.4-11

Older adults with AML, when compared to younger patients with the same disease, have a poor prognosis and represent a discrete population in terms of disease features (including the biology of the disease and the incidence of secondary leukemia), treatment-related complications, and overall outcome (Table 5.1). As a result, older patients require distinctive management approaches to determine whether standard treatment, investigational treatment, or low-dose therapy or palliative care is most appropriate.

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