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. 2013 May 5;3(2):141-64.
Print 2013.

Treatment of older patients with acute myeloid leukemia (AML): a Canadian consensus

Joseph M Brandwein  1 , Michelle Geddes, Jeannine Kassis, Andrea K Kew, Brian Leber, Thomas Nevill, Mitchell Sabloff, Irwindeep Sandhu, Andre C Schuh, John M Storring, John Ashkenas
Affiliations

Treatment of older patients with acute myeloid leukemia (AML): a Canadian consensus

Joseph M Brandwein et al. Am J Blood Res. .

Abstract

Patients over age 60 comprise the majority of those diagnosed with acute myeloid leukemia (AML), but treatment approaches in this population are variable, with many uncertainties and controversies. Our group conducted a literature review to summarize the latest information and to develop a consensus document with practical treatment recommendations. We addressed five key questions: selection criteria for patients to receive intensive induction chemotherapy; optimal induction and post-remission regimens; allogeneic hematopoietic stem cell transplantation (HSCT); treatment of patients not suitable for induction chemotherapy; and treatment of patients with prior hematological disorders or therapy-related AML. Relevant literature was identified through a PubMed search of publications from 1991 to 2012. Key findings included the recognition that cytogenetics and molecular markers are major biologic determinants of treatment outcomes in the older population, both during induction therapy and following HSCT. Although disease-specific and patient-specific risk factors for poor outcomes are more common in the older population, age is not in itself sufficient grounds for withholding established treatments, including induction and consolidation chemotherapy. The role of HSCT and use of hypomethylating agents are discussed. Finally, suggested treatment algorithms are outlined, based on these recommendations.

Keywords: Acute myeloid leukemia; chemotherapy; cytogenetics; hematopoietic stem cell transplantation; hypomethylating agent; prognosis.

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Figures

Figure 1
Figure 1
Treatment of older AML patients deemed medically fit for induction who are also potential candidates for hematopoietic stem cell transplant (HSCT). BSC = best supportive care; CR = complete response; HiDAC = high-dose cytarabine.
Figure 2
Figure 2
Treatment of older AML patients deemed medically fit for induction who are not candidates for HSCT. BSC = best supportive care; CR = complete remission; HiDAC = high-dose cytarabine.
Figure 3
Figure 3
Treatment of older AML patients not deemed fit for induction. BSC = best supportive care; LD-AraC = low-dose cytarabine.
See this image and copyright information in PMC

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