Therapeutic Choice in Older Patients with Acute Myeloid Leukemia: A Matter of Fitness

Abstract

Acute myeloid leukemia (AML), with an incidence increasing with age, is the most common acute leukemia in adults. Concurrent comorbidities, mild to severe organ dysfunctions, and low performance status (PS) are frequently found in older patients at the onset, conditioning treatment choice and crucially influencing the outcome. Although anthracyclines plus cytarabine-based chemotherapy, also called “7 + 3” regimen, remains the standard of care in young adults, its use in patients older than 65 years should be reserved to selected cases because of higher incidence of toxicity. These adverse features of AML in the elderly underline the importance of a careful patient assessment at diagnosis as a critical tool in the decision-making process of treatment choice. In this review, we will describe selected recently approved drugs as well as examine prognostic algorithms that may be helpful to assign treatment in elderly patients properly.

Patterns of undertreatment among patients with acute myeloid leukemia (AML): considerations for patients eligible for non-intensive chemotherapy (NIC)

“…Since 2017, new NIC options beyond low-dose cytarabine and HMAs have been available to extend survival in patients with AML who are not candidates for IC; however, the findings of this review suggest a substantial proportion of patients who might benefit from such treatment do not receive it (Wang 2014;Shallis et al 2019;Bories et al 2018;Griffiths et al 2020;Palmieri et al 2020). Across identified studies, patients treated with NIC experienced longer OS than those who received NAAT.…”

CPX‐351 (Vyxeos®) can cause severe rash in acute myeloid leukemia—A case report

“…Finally, this decision was justified by taking the patient's clinical condition, comorbidities, and physical fitness into consideration. 29 CR was achieved after one cycle of CPX-351. For subsequent consolidation therapy, intermediate-dose cytarabine was chosen to reduce the risk for a reoccurring rash resulting in ongoing CR.…”

“…Complete remission (CR) rates were also significantly improved by CPX‐351 (37.3% vs 25.6% with 7 + 3). Finally, this decision was justified by taking the patient's clinical condition, comorbidities, and physical fitness into consideration 29 . CR was achieved after one cycle of CPX‐351.…”

Drug responsiveness of leukemic cells detected in vitro at diagnosis correlates with therapy response and survival in patients with acute myeloid leukemia

“…Patients received treatment in accordance with the standard clinical guidelines and recommendations. 13 , 14 …”

“…Patients received treatment in accordance with the standard clinical guidelines and recommendations. 13,14 AML patients were assigned into two groups: "primary" and "secondary." Patients with newly diagnosed acute leukemia not receiving chemotherapy were attributed to "primary."…”