The Clinical Experience of Integrated Traditional Chinese and Western Medicine in Treating Elderly Acute Myeloid Leukemia of SHEN Yiping / 浙江中医药大学学报

[Objective] To summarize Dr. SHEN Yiping's clinical experience of integrated traditional Chinese and western medicine in treating elderly acute myeloid leukemia (AML). [Methods]By examining with cases of illness and warding round,collecting the medical records of elderly AML patients treated by Dr. SHEN, learning the latest diagnosis and treatment guidelines, reading a large number of related papers and a large number of classical books, from the aspects of etiology and pathogenesis, therapeutic principles and methods, the clinical experience of the treatment of elderly AML were analyzed and summarized, and one medical record was provided.[Results]Dr. SHEN believes that the pathogenesis is deficiency syndrome accompanied with excess syndrome. Mostly due to congenital deficiency and poor basic functions, deficiency of spleen and kidney, heat poison intrusion, burning Jin as sputum, forcing blood going in wrong line, phlegm and blood stasis, evil accumulating in bone marrow and then suffered. Dr. SHEN uses heat-clearing, detoxifying and anti-cancer drugs to suppress and eliminate leukemia cells on the basis of chemotherapy and supplements beneficial drugs to achieve the goal of chemotherapy without harming the positive effect, he uses "Kangbai Yannian Tang" combined with decitabine and chemotherapy as a basic solution and changes flexibly by according to the clinical manifestations, changes of syndrome types of the patients, the clinical effect is remarkable, and the case had good results. [Conclusion]Dr. SHEN is good at integrated traditional Chinese and western, combining of syndrome differentiation and disease differentiation, using the combination of heat-clearing method and complement in the treatment of elderly AML, the experience and wonderful methods are worth learning and spreading.

Is there a role for metronomic induction (and maintenance) therapy in elderly patients with acute myeloid leukemia: A literature review.

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.

Induction Chemotherapy for Patients with Acute Myeloid Leukemia Aged over 60 Years / 대한혈액학회지

BACKGROUND: Clinical and biologic characteristics of elderly patients with acute myeloid leukemia (AML) have not been well defined yet and there is no consensus on the appropriate treatment approach. We analyzed the outcome of these patients in terms of complete remission (CR) and the long-term life expectancy. METHODS: Twenty patients received mitoxantrone at the dose range of 4~8 mg/m2/ day for 3 days according to the patients' condition based on age and performance status, low-dose cytosine arabinoside 10mg/m2 subcutaneously at every 12 hours for 10~14 days, and etoposide 100mg/day per os for 10~14 days. Most of patients achieving CR received at least 1~3 more courses of post-remission therapy with same initial regimen. Nine out of 17 patients receiving more than two courses of post-remission chemotherapy received their cryopreserved peripheral bloods stem cells after the second or third consolidation chemotherapy. RESULTS: Overall, CR was achieved in 16 (80%) out of 20 patients and the median CR duration was 6 months (range 2~17 months). The most frequent complication during the induction chemotherapy was pneumonia (55%). CONCLUSION: The induction chemotherapy regimen including mitoxantrone, cytosine arabinoside, and etoposide seems to be promising in elderly AML patients in terms of CR rate, while its duration was short. Hopefully, it is necessary to develop a new post-remission therapy to maintain long-term disease-free survival in elderly AML patients.