Management of acute myeloid leukaemia

Abstract

In a retrospective audit data were collected on all 231 patients from 26 hospitals diagnosed with AML in the south and west region of the UK in 1996. Their median age at diagnosis was 67 years. Sixty one percent (142/231) of patients were treated with chemotherapy; most of the rest received blood product support only; and 7% (15) had no treatment at all. Sixty eight percent of patients aged under 60 years were treated in a clinical trial compared with 24% of patients over 60. The major reasons given for not entering patients in a trial were ineligibility in the younger cohort and poor performance status in the older group. Twenty elderly patients (12.5%) refused to be entered in a trial.

In an unselected cohort of patients with AML the accrual into clinical trials is impressively high for patients under 60 years. However, this is a disease of the elderly and comparable enrolment is not seen with elderly patients despite being managed by the same haematologists. If the percentage of patients entered into trials is to be defined as a quality standard, then it is important for those trials to be relevant to the population being treated.