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H. Joachim Deeg and Marcos de Lima

Myelodysplastic syndrome is primarily a disease of older age, and hematopoietic cell transplantation is the only treatment modality that offers the potential of cure and long-term survival to a substantial proportion of patients. Transplantation is used with increasing frequency in older patients, and patients in the seventh or even eighth decade of life have been transplanted successfully. However, transplant outcome strongly depends on the disease characteristics and comorbid conditions, which tend to be common in older individuals and profoundly affect nonrelapse mortality. This is a major reason why in patients older than 60 years, typically only conditioning regimens of reduced intensity are used. However, although these regimens are associated with little acute toxicity, the probability of relapse tends to be higher than with high-intensity regimens. In addition, chronic graft-versus-host disease occurs in as many as 50% to 60% of patients. Manifestations are mild in a proportion of patients; others require long-term treatment, generally with glucocorticoids, which often are not well tolerated in older individuals. Although considerable progress has been made over the past decade, more work is needed, particularly to reduce the incidence of severe graft-versus-host disease and prevent posttransplant relapse.

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Margaret R. O'Donnell, Martin S. Tallman, Camille N. Abboud, Jessica K. Altman, Frederick R. Appelbaum, Daniel A. Arber, Vijaya Bhatt, Dale Bixby, William Blum, Steven E. Coutre, Marcos De Lima, Amir T. Fathi, Melanie Fiorella, James M. Foran, Steven D. Gore, Aric C. Hall, Patricia Kropf, Jeffrey Lancet, Lori J. Maness, Guido Marcucci, Michael G. Martin, Joseph O. Moore, Rebecca Olin, Deniz Peker, Daniel A. Pollyea, Keith Pratz, Farhad Ravandi, Paul J. Shami, Richard M. Stone, Stephen A. Strickland, Eunice S. Wang, Matthew Wieduwilt, Kristina Gregory and Ndiya Ogba

Acute myeloid leukemia (AML) is the most common form of acute leukemia among adults and accounts for the largest number of annual deaths due to leukemias in the United States. This portion of the NCCN Guidelines for AML focuses on management and provides recommendations on the workup, diagnostic evaluation, and treatment options for younger (age <60 years) and older (age ≥60 years) adult patients.

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Martin S. Tallman, Eunice S. Wang, Jessica K. Altman, Frederick R. Appelbaum, Vijaya Raj Bhatt, Dale Bixby, Steven E. Coutre, Marcos De Lima, Amir T. Fathi, Melanie Fiorella, James M. Foran, Aric C. Hall, Meagan Jacoby, Jeffrey Lancet, Thomas W. LeBlanc, Gabriel Mannis, Guido Marcucci, Michael G. Martin, Alice Mims, Margaret R. O’Donnell, Rebecca Olin, Deniz Peker, Alexander Perl, Daniel A. Pollyea, Keith Pratz, Thomas Prebet, Farhad Ravandi, Paul J. Shami, Richard M. Stone, Stephen A. Strickland, Matthew Wieduwilt, Kristina M. Gregory, OCN, Lydia Hammond and Ndiya Ogba

Acute myeloid leukemia (AML) is the most common form of acute leukemia among adults and accounts for the largest number of annual deaths due to leukemias in the United States. Recent advances have resulted in an expansion of treatment options for AML, especially concerning targeted therapies and low-intensity regimens. This portion of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for AML focuses on the management of AML and provides recommendations on the workup, diagnostic evaluation and treatment options for younger (age <60 years) and older (age ≥60 years) adult patients.