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Management of Acute Myeloid Leukemia (AML) in Older Patients

  • Geriatric Oncology (L Balducci, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The acute myeloid leukemia (AML) treatment landscape has rapidly evolved over the past few years. These changes have several implications for the care of older adults (≥ 60 years), who have inferior clinical outcomes. We review decision-making in older adults, focusing on patient- and disease-related factors. We then summarize current treatment options, including multiple recently approved therapies, based on hypothetical clinical scenarios.

Recent Findings

In lieu of using chronological age to determine fitness, we highlight the importance of standardized fitness assessments using geriatric assessments. Next, we review intensive and lower-intensity treatment options in the upfront setting. We focus on multiple newly approved medications, including venetoclax, midostaurin, CPX-351, gemtuzumab, glasdegib, enasidenib, and ivosidenib, and their specific indications. Lastly, we briefly discuss supportive care of older adults with AML.

Summary

Outcomes of older adults with AML remain poor; fortunately, there are many new promising treatment options. Personalized treatment plans based on patient- and disease-specific factors are essential to the care of older adults with AML.

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Acknowledgment

We would like to acknowledge Dr. Susan Rosenthal, MD, for her editorial assistance.

Funding

Dr. Loh is supported by the National Cancer Institute at the National Institute of Health (K99CA237744) and Wilmot Research Fellowship Award.

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Authors and Affiliations

  1. Sections of Hematology/Oncology & Geriatrics, Department of Medicine, Boston University School of Medicine, Boston, MA, USA

    Maya Abdallah

  2. Depatment of Hematology, Mayo Clinic, Rochester, MN, USA

    Zhuoer Xie

  3. Department of Medicine, University of Massachusetts - Baystate Medical Center, Springfield, MA, USA

    Audrey Ready

  4. Department of Medicine, Rochester General Hospital, Rochester, NY, USA

    Dharmini Manogna

  5. Division of Hematology/Oncology, University of Rochester Medical Center, James P. Wilmot Cancer Center, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA

    Jason H. Mendler & Kah Poh Loh

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  1. Maya Abdallah
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Correspondence to Kah Poh Loh.

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Dr. Loh serves as a consultant to Pfizer and Seattle Genetics. Maya Abdallah, Zhuoer Xie, Audrey Ready, and Dharmini Manogna declare no conflict of interest. Jason H. Mendler has received speaker’s honorarium from Jazz Pharmaceuticals and has received compensation from Karyopharm Therapeutics for service on an advisory board. Kah Poh Loh has received compensation from Pfizer and Seattle Genetics for service as a consultant.

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Abdallah, M., Xie, Z., Ready, A. et al. Management of Acute Myeloid Leukemia (AML) in Older Patients. Curr Oncol Rep 22, 103 (2020). https://doi.org/10.1007/s11912-020-00964-1

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