Acute myeloid leukemia in patients we judge as being older and/or unfit
Research output: Contribution to journal › Review article
Definition of older age in AML is arbitrary. In the context of the clinical studies, it starts with age ≥ 60 or ≥65 years and in recent years ≥70 or 75, depending on the selection of the studied population. In clinical practice, with older age we often mean that the patient is unfit for intensive chemotherapy. Higher age overlaps with categories such as worse performance status, unfitness, co-morbidities, poor-risk cytogenetics, adverse mutation patterns, age-related clonal hematopoiesis and specific disease ontogeny. Intensive induction therapy can result in prolonged overall survival, at least in a subset of elderly patients aged up to 75 years despite the reluctance of some physicians and patients to use treatment regimens perceived as toxic. Venetoclax and azacytidine combination is the new standard of comparison for persons unfit for intensive therapy. New oral hypomethylating agent CC-486 as maintenance therapy led to a prolonged overall survival in a randomized trial of patients ≥ 55 years or age who were in first complete remission, not eligible for allogeneic stem cell transplantation. Any therapy is better than no therapy, but a substantial proportion of older patients still receive only palliative care. Making a decision for AML diagnosed in older age should be individualized and shared through the dialog with the patient and relatives or cohabitants, considering medical issues as well as social factors including personal goals. Although we are witnesses of the advances in basic research and therapy, we are still a very long way from curing older patients with AML.
|Research areas and keywords||
Subject classification (UKÄ) – MANDATORY
|Journal||Journal of Internal Medicine|
|Publication status||E-pub ahead of print - 2021 Mar 29|