Evolving Therapeutic Approaches for Older Patients with Acute Myeloid Leukemia in 2021

Abstract

Acute myeloid leukemia (AML) in older patients is characterized by unfavorable prognosis due to adverse disease features and a high rate of treatment-related complications. Classical therapeutic options range from intensive chemotherapy in fit patients, potentially followed by allogeneic hematopoietic cell transplantation (allo-HCT), to hypomethylating agents or palliative care alone for unfit/frail ones. In the era of precision medicine, the treatment paradigm of AML is rapidly changing. On the one hand, a plethora of new targeted drugs with good tolerability profiles are becoming available, offering the possibility to achieve a prolonged remission to many patients not otherwise eligible for more intensive therapies. On the other hand, better tools to assess patients’ fitness and improvements in the selection and management of those undergoing allo-HCT will hopefully reduce treatment-related mortality and complications. Importantly, a detailed genetic characterization of AML has become of paramount importance to choose the best therapeutic option in both intensively treated and unfit patients. Finally, improving supportive care and quality of life is of major importance in this age group, especially for the minority of patients that are still candidates for palliative care because of very poor clinical conditions or unwillingness to receive active treatments. In the present review, we discuss the evolving approaches in the treatment of older AML patients, which is becoming increasingly challenging following the advent of new effective drugs for a very heterogeneous and complex population.

Comparison of Hospital Length of Stay and Supportive Care Utilization Between Patients Treated with CPX-351 and 7+3 for Therapy-Related Acute Myeloid Leukemia or Acute Myeloid Leukemia with Myelodysplasia-Related Changes

“…In addition to CPX-351, agents recently approved in the United States include lower-intensity regimens, such as venetoclax in combination with HMAs or low-dose cytarabine, and targeted agents, such as midostaurin (FLT3 inhibitor), gilteritinib (FLT3 inhibitor), ivosidenib (IDH1 inhibitor), enasidenib (IDH2 inhibitor), glasdegib (Hedgehog signaling pathway inhibitor), or gemtuzumab ozogamicin (anti-CD33 antibody conjugate). 32 , 33 Together, these newer agents are associated with good tolerability profiles and/or improved efficacy for segments of the AML population and permit more personalized treatment plans. Additional clinical data are needed to further refine the optimal treatment paradigm.…”

Gilteritinib in Isolated Breast Relapse of <b><i>FLT3</i></b> Positive Acute Myeloid Leukemia: A Case Report and Review of Literature

“…The CR rate was 34% in the gilteritinib group versus 15.3% in the chemotherapy one, and median OS was significantly longer with gilteritinib (9.3 vs. 5.6 months). Following these results, gilteritinib has been approved for relapsed/refractory FLT3-mutated AML patients [4, 31].…”

Modern Risk Stratification of Acute Myeloid Leukemia in 2023: Integrating Established and Emerging Prognostic Factors

“…Comorbidities are evaluated using different scores able to identify patients who would not benefit from intensive chemotherapy [ 10 ], which could also be used to estimate patients’ outcomes [ 1 ]. Indeed, simple parameters such as NT-proBNP could be particularly helpful for identifying patients at higher risk of early mortality [ 11 ].…”

“…However, it is important to consider that prognostic stratification in a specific therapeutic context significantly differs from a theragnostic-oriented approach. In the present review, we will focus on prognosis only, as an extensive discussion on how prognostic factors influence treatment choices can be found elsewhere [ 1 , 2 ].…”