Is there a role for metronomic induction (and maintenance) therapy in elderly patients with acute myeloid leukemia: A literature review.
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Date
2013-04
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Abstract
Acute myeloid leukemia (AML) in older adults differs biologically and clinically from that in younger patients and is
characterized by adverse chromosomal abnormalities, stronger intrinsic resistance, and lower tolerance to chemotherapy.
In patients over age 60 with AML, cure rates are under 10% despite intensive chemotherapy, and most of them die within a
year of diagnosis. Over the last decade, metronomic chemotherapy has emerged as a potential strategy to control advanced/
refractory cancer. Here, we report a case of a 68‑year‑old gentleman having AML with high‑risk cytogenetic features, who
achieved complete remission on our oral metronomic PrET (PrET: Prednisolone, etoposide, thioguanine) protocol on an
outpatient basis. He was later treated with standard high‑dose (HD) cytosine arabinoside (Ara‑C) consolidation followed by
maintenance with etoposide, thioguanine, and sodium valproate. Presently, the patient is nearly 35 months since diagnosis
and 21 months off treatment. This case report and review highlights that the combination of oral low‑intensity metronomic
therapy, followed by standard HD consolidation therapy and metronomic maintenance therapy may be well tolerated by
elderly patients especially with less proliferative, high (cytogenetic)‑risk AML who are otherwise deemed to be unfit for
intensive intravenous induction chemotherapy regimens. References for this review were identified through searches of
Pubmed for recent publications on the subject as well as searches of the files of the authors themselves. The final list was
generated on the basis of originality and relevance to this review.
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Keywords
Elderly acute myeloid leukemia, metronomic therapy, metronomics, oral etoposide, oral 6TG
Citation
Tandon N, Banavali S, Menon H, Gujral S, Kadam P A, Bakshi A. Is there a role for metronomic induction (and maintenance) therapy in elderly patients with acute myeloid leukemia: A literature review. Indian Journal of Cancer. 2013 Apr-June; 50(2): 154-158.