How old is old: the beginning of a new era for therapeutic challenges for elderly patients with AML

which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Editorial How old is old: the beginning of a new era for therapeutic challenges for elderly patients with AML When patients with acute myeloid leukemia (AML) relapse, prognosis is considered dismal, even if the patient experiences a long period of complete remission (CR). Although we live in an era of genomic and epigenomic information, the management of elderly Korean patients with AML remains a challenge, given the patient's age, poor performance status, and various pre-existing comor-bidities. As we know, the incidence of AML increases sharply with age, especially after the age of 55. According to the Surveillance, Epidemiology, and End Results (SEER) data (2006–2010), almost 70% of AML patients are ＞55 years old, with the peak incidence occurring at ＞75 years [1-3]. Unfortunately, most elderly AML patients do not receive intensive therapies, due to their age, a pattern that is based on the common misconception that elderly patients cannot tolerate chemotherapies. US SEER data from 2000– 2007 revealed that only one third of elderly AML patients received early chemotherapy after initial diagnosis [2], although no Korean data exists to date. However, higher comorbidities and poor performance status, have a greater negative impact than age per se. Although there have been no large efficacy trials for these patients, large registry data, in addition to some positive retrospective studies, have shown that intensive induction therapy can improve survival [4-6]. There are currently many ongoing trials for selected elderly AML patients, including some with post-CR allogeneic hematopoietic stem cell transplantation (alloHSCT) approaches. However, a well designed treatment for elderly AML patients should be examined prospectively to determine whether patients who receive less toxic therapies achieve CR, whether post-CR alloHSCT may be avoided, and whether a true cure can be found with recent novel therapeutic agents. In the present issue of Blood Research, Yi et al. [7] found that carefully selected elderly Korean AML patients (median age 70 years) experienced beneficial effects after treatment with either high-intensity regimens (HIR) or low-intensity regimens (LIR). The authors found that the median survival periods with HIR and LIR were 6.8 and 10.2 months, respectively, compared to just 1.6 months for patients who only received supportive care (SC). Multivariate analysis of the 168 patients, diagnosed in five institutes, identified age, ECOG performance status, Hb level, and serum creatinine at diagnosis …