Older Patients with Acute Myeloid Leukemia Deserve Individualized Treatment

Abstract

Purpose of review: Treatment of elderly patients with acute myeloid leukemia is a known challenge for hematologists due to patient diversity, heterogeneous disease biology, and a rapidly evolving treatment landscape. Here, we highlight the importance of determining fitness, review the latest therapeutic developments, and discuss clinical scenarios to provide guidance on individualized treatment for older AML patients.

Recent findings: Several factors, like age, performance status, and comorbidities, play a role in fitness and are associated with outcome. Comorbidity scoring systems and geriatric assessments are tools to help physicians select the most appropriate treatment for each patient. The addition of venetoclax, targeted therapy with IDH1/2 and FLT3 inhibitors, and enhanced formulas of existing drugs like CPX-351 and oral azacitidine have improved responses and outcomes. New drugs and combination therapies have increased the therapeutic options for elderly AML patients but determination of fitness and disease biology is essential to select patient-tailored treatments.

Keywords: Acute myeloid leukemia; Azacitidine; CC-486; CPX-351; Decitabine; Elderly; Enasidenib; FTL3 inhibitors; Fitness; Gemutuzumab ozogamicin; Gilteritinib; Glasdegib; Hematopoietic stem cell transplantation; Hypomethylating agents; IDH inhibitors; Intensive chemotherapy; Ivosidenib; Midostaurin; Targeted therapy; Treatment; Venetoclax; Vyxeos.

Fig. 1

Purposed treatment algorithm for elderly AML patients. CBF-AML, core-binding factor acute myeloid leukemia; FLT3m, FMS-like tyrosine kinase mutated; tAML, therapy-related AML; AML-MRC, AML with myelodysplasia-related changes; GO, gemtuzumab ozogamicin; HMA, hypomethylating agent; IDH1m, isocitrate dehydrogenase 1 mutated; IDH2m, isocitrate dehydrogenase 2 mutated; LDAC, low-dose cytarabine; BSC, best supportive care.