ABSTRACT
Moreover, most of the patients diagnosed with a haematological disorder are above the age of 60 with other co-morbidities, which render the use of chemotherapy even more controversial. Undoubtedly, this increases the non-disease related mortality and puts more pressure on the adverse disease related outcomes.4 But even for the younger patients, there are tremendous variations in outcomes that highlight the unpredictable responses to the ordinary chemotherapy regimen and the unexpected toxicities. One of the most striking examples of this is the differences in outcomes for the different young age groups in acute lymphoblastic leukaemia. Patients in the age group 2-10 years old have a five-year overall survival of 85%, compared to 50% for the age group 10-25 years. Although molecular genetics and modern diagnostics have aided in the direction of disease risk assessment, the use of a more toxic regimen for the high risk patients ended in more deaths as a result of the treatment toxicities.5 The impact of both disease and treatment toxicities on the quality of life of these patients cannot be underestimated either. Most of them will spend a significant proportion of their everyday life in a hospital, either to receive treatment or to have the side effects of the treatment managed by specialist services. For the health services themselves, it translates into increased acute bed occupancy, which essentially means less space for other patients in need of treatment and also a sharp rise in the utilisation of the taxpayer’s money.6 The complexities of management for haematological patients are highlighted below where outcomes of acute leukaemias are discussed7-9: 4.1.1 Acute Myeloid Leukaemia Outcomes
Figure 4.1 demonstrates the dramatic improvement in the outcomes of AML in different age groups between 1980-1984 and 20002004. Another difference, however, is the sharp decline in survival in the age groups of 55 and above, which becomes even more profound above the age of 65. In this age group, it is shown that the outcomes, irrespective of the year being treated, remain equally poor with no major difference. The reason might be that these patients (especially above the age of 65) have less chances of undergoing intensification of their treatment with an allogeneic bone marrow transplant and also that they experience more deaths as a direct consequence of the chemotherapy toxicities
Figure 4.1 improvement in the outcomes of AML in different age groups between 1980-1984 (straight line) and 2000-2004 (dashed line). Even for patients who are able to undergo a bone marrow
transplant, the five-year overall survival does not exceed 40% for patients in their first or second complete remission (see Figure 4.2). For patients with advanced disease, however, the five-year overall survival falls to less than 20%, indicating that even the most intensive treatment gives a suboptimal response.
