Joan Besalduch Josep-maria Sánchez Montserrat Batlle Pilar Vivancos Enric Carreras Josep-maria Vilà Antoni Julià Jordi Sierra Emili Montserrat

Intensive induction and consolidation therapy with agents such as idarubicin and high-dose cytarabine and hematopoietic stem cell transplantation are the mainstay in the treatment of acute myeloid leukemia (AML). However, while the incidence of AML increases with age, these treatments provide greater benefit to younger rather than to older patients. More than one half of the patients with AML are older than 60 years and, therefore, most are not candidates for intensive therapies because of co-morbid conditions or impaired general status. In patients fit enough for treatment, other factors contribute to a poorer outcome. These factors include a lower tolerance to prolonged pancytopenia and intensive therapy, resulting in a higher mortality during induction, and a higher frequency of AML with poor-risk features such as poor-risk karyotypes, previous myelodysplastic syndrome (MDS) and multidrug resistance (MDR) phenotype, all resulting in a higher resistance to chemotherapy. Anthracycline and cytarabine regimens in patients over 60 years old result in complete remission (CR) rates lower than 50% and longterm survival rates of about 10%. Improved supportive therapy (i.e. new antibiotic and antifungal agents and growth-factors) and the invariably poor prognosis of patients treated with nonintensive therapies may have diminished the reluctance to expose elderly patients to intensive antileukemic schedules. However, the proportion of patients entered into clinical trials is usually not reported and the results may reflect the effect of selection rather than therapy. The Catalan Group for the Study of Acute Leukemias and Myelodysplastic Syndromes Background and Objectives. The benefits of high-dose cytarabine, anthracyclines and hematopoietic stem cell transplantation in the treatment of acute myeloid leukemia (AML) are greater in younger rather than in older patients. We assessed the proportion of patients over 60 years with de novo AML who qualified for intensive therapy and determined the feasibility and results of autologous stem cell transplantation (ASCT) in first complete remission (CR).