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. 2020 Aug 11;4(15):3528-3549.
doi: 10.1182/bloodadvances.2020001920.

American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

Mikkael A Sekeres  1 , Gordon Guyatt  2 , Gregory Abel  3 , Shabbir Alibhai  4 , Jessica K Altman  5 , Rena Buckstein  6 , Hannah Choe  7 , Pinkal Desai  8 , Harry Erba  9 , Christopher S Hourigan  10 , Thomas W LeBlanc  9 , Mark Litzow  11 , Janet MacEachern  12 , Laura C Michaelis  13 , Sudipto Mukherjee  1 , Kristen O'Dwyer  14 , Ashley Rosko  7 , Richard Stone  3 , Arnav Agarwal  15 , L E Colunga-Lozano  2   16 , Yaping Chang  2 , QiuKui Hao  2   17 , Romina Brignardello-Petersen  2
Affiliations

American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

Mikkael A Sekeres et al. Blood Adv. .

Abstract

Background: Older adults with acute myeloid leukemia (AML) represent a vulnerable population in whom disease-based and clinical risk factors, patient goals, prognosis, and practitioner- and patient-perceived treatment risks and benefits influence treatment recommendations.

Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about management of AML in older adults.

Methods: ASH formed a multidisciplinary guideline panel that included specialists in myeloid leukemia, geriatric oncology, patient-reported outcomes and decision-making, frailty, epidemiology, and methodology, as well as patients. The McMaster Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline-development process, including performing systematic evidence reviews (up to 24 May 2019). The panel prioritized clinical questions and outcomes according to their importance to patients, as judged by the panel. The panel used the GRADE approach, including GRADE's Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment.

Results: The panel agreed on 6 critical questions in managing older adults with AML, mirroring real-time practitioner-patient conversations: the decision to pursue antileukemic treatment vs best supportive management, the intensity of therapy, the role and duration of postremission therapy, combination vs monotherapy for induction and beyond, duration of less-intensive therapy, and the role of transfusion support for patients no longer receiving antileukemic therapy.

Conclusions: Treatment is recommended over best supportive management. More-intensive therapy is recommended over less-intensive therapy when deemed tolerable. However, these recommendations are guided by the principle that throughout a patient's disease course, optimal care involves ongoing discussions between clinicians and patients, continuously addressing goals of care and the relative risk-benefit balance of treatment.

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Conflict of interest statement

Conflict-of-interest disclosure: All authors were members of the guideline panel or members of the systematic review team or both. As such, they completed a disclosure-of-interest form, which was reviewed by ASH and is available as supplemental Files 2 and 3.

Comment in

References

    1. Schünemann HJ, Wiercioch W, Etxeandia I, et al. . Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise. CMAJ. 2014;186(3):E123-E142. - PMC - PubMed
    1. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines; Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E, eds. Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Press; 2011. - PubMed
    1. Qaseem A, Forland F, Macbeth F, Ollenschläger G, Phillips S, van der Wees P; Board of Trustees of the Guidelines International Network. Guidelines International Network: toward international standards for clinical practice guidelines. Ann Intern Med. 2012;156(7):525-531. - PubMed
    1. Schünemann HJ, Al-Ansary LA, Forland F, et al. ; Board of Trustees of the Guidelines International Network. Guidelines International Network: principles for disclosure of interests and management of conflicts in guidelines. Ann Intern Med. 2015;163(7):548-553. - PubMed
    1. Alonso-Coello P, Oxman AD, Moberg J, et al. ; GRADE Working Group. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. BMJ. 2016;353:i2089. - PubMed

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