How I treat acute myeloid leukemia presenting with preexisting comorbidities

Abstract

Acute myeloid leukemia (AML) is a devastating disease with an incidence that progressively increases with advancing age. Currently, only ∼40% of younger and 10% of older adults are long-term survivors. If untreated, the overall prognosis of AML remains dismal. Initiation of therapy at diagnosis is usually urgent. Barriers to successful therapy for AML are the attendant toxicities directly related to chemotherapy or those associated with inevitable aplasia. Organ dysfunction often further complicates such toxicities and may even be prohibitive. There are few guidelines to manage such patients and the fear of crossing the medico-legal abyss may dominate. Such clinical scenarios provide particular challenges and require experience for optimal management. Herein, we discuss select examples of common pretreatment comorbidities, including cardiomyopathy, ischemic heart disease; chronic renal failure, with and without dialysis; hepatitis and cirrhosis; chronic pulmonary insufficiency; and cerebral vascular disease. These comorbidities usually render patients ineligible for clinical trials and enormous uncertainty regarding management reigns, often to the point of withholding definitive therapy. The scenarios described herein emphasize that with appropriate subspecialty support, many AML patients with comorbidities can undergo therapy with curative intent and achieve successful long-term outcome.

Anthracycline-related cardiotoxicity in older patients with acute myeloid leukemia: a Young SIOG review paper

“…However, expert opinion suggests that non-anthracycline induction strategies should be considered where there is concern for tolerability of anthracycline-containing induction therapy. 95 Several anthracyclinefree intensive induction regimens have shown similar efficacy in comparison with "713" regimen, although only a minority was tested in randomized trials. [96][97][98][99][100] These options are listed in Table 6.…”

Circ-ANAPC7 is Upregulated in Acute Myeloid Leukemia and Appears to Target the MiR-181 Family

“…Despite rapid advances in AML therapy, including the development of novel drug targets and transplantation, treatment has remained stagnant for the past few decades, with most patients relapsing and dying of complications [16]. Even with current treatment, the majority of patients older than 65 years will die of AML within 1 year [17,18]. To address this issue, research has focused on the identification of novel targets for AML therapy.…”

Comorbidity, Physical Function, and Quality of Life in Older Adults with Acute Myeloid Leukemia

“…Treatment choice also depends on a variety of factors, including age, performance status, and comorbidities (25). Studies have shown older patients with AML can benefit from standard therapy regimens; however, there is often reluctance among clinicians especially in the presence of comorbidities due to the difficulty of predicting risk/benefits of available therapies (11, 17, 26).…”