Table 1.
Six Vignettes of Elderly Patients with AML
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Instructions: For each vignette, choose the one you would recommend most among the following three choices: (1) standard-dose intensive chemotherapy, including the classical 7+3 regimen (daunorubicin 60–90 mg/m2 or idarubicin 12 mg/m2, days 1–3, with cytarabine 100 mg/m2 q12h, days 1–7); (2) low-intensity chemotherapy, including a reduced-dose 7+3 regimen, hypomethylating drugs (decitabine or azacitidine), or CAG regimen (cytarabine, aclarubicin, G-CSF); or (3) best supportive care (without chemotherapies). | |
| Vignette 1: A 70-year-old woman with an 11-year history of hypertension controlled by ACEIs. Her LVEF was 59%. ECOG 1. CBC: WBC 11 × 109/L, hemoglobin 100 g/L, platelets 78 × 109/L, peripheral blast 12%. BMA: FAB2 AML with favorable karyotype translocation (8;21). | |
| Vignette 2: A 66-year-old male with a long history of smoking. He was diagnosed with coronary artery disease with coronary artery stenting in 2011, after which he quit smoking. Recently, he lost 5% of his body weight (from 80 kilograms to 76 kilograms). His LVEF was 51%. ECOG 2. CBC: WBC 82 × 109/L, neutrophils 0.3 × 109/L, hemoglobin 92 g/L, platelets 50 × 109/L, peripheral blast 55%. BMA: FAB2 AML with 66% blast cells, normal karyotype, and FLT3-ITDlow mutation. | |
| Vignette 3: A 72-year-old male with no comorbidity. He had untreated myelodysplastic syndrome (IPSS 0.5) since 2011. He had worsening anemia since 2016 and was still afebrile and independent of transfusion. ECOG 2. CBC: WBC 1 × 109/L, neutrophils 0.3 × 109/L, hemoglobin 90 g/L, platelets 120 × 109/L, peripheral blast 6%. BMA: FAB2 AML with 40% blast cells, and complex karyotype (inversion 3, 5q-, 7-). | |
| Vignette 4: A 61-year-old male. He had asymptomatic coronary artery stenosis (70–90%) with normal cardiac function. He felt feeble recently. ECOG 2. CBC: WBC 15 × 109/L, hemoglobin 78 g/L, platelets 30 × 109/L, peripheral blast 13%. BMA: FAB2 AML with normal karyotype. | |
| Vignette 5: A 63-year-old male with type 2 diabetes mellitus. He had small infarcts in the left cerebrum with no complications after successful thrombolysis 18 months ago. ECOG 2. CBC: WBC 55 × 109/L, hemoglobin 78 g/L, platelets 30 × 109/L, peripheral blast 25%. BMA: FAB2 AML with pathological hematopoiesis of erythrocytes and megakaryocytes and complex karyotype. | |
| Vignette 6: A 70-year-old male with asymptomatic coronary artery stenosis (70–90%) with normal cardiac function. He felt feeble recently. ECOG 2. CBC: WBC 15 × 109/L, hemoglobin 78 g/L, platelets 30 × 109/L, peripheral blast 13%. BMA: FAB2 AML with normal karyotype. |
G-CSF, granulocyte-colony-stimulating factor; LVEF, left ventricular ejection fraction; ACEIs, angiotensin-converting enzyme inhibitors; ECOG, Eastern Cooperative Oncology Group performance status; CBC, complete blood count; WBC, white blood cell; BMA, bone marrow aspiration; FAB, French-American-British; AML, acute myeloid leukemia