Update on Optimal Management of Acute Myeloid Leukemia

Abstract

Acute myeloid leukemia (AML) represents a malignant accumulation of immature myeloid cells in the marrow, presenting with impaired hematopoiesis and its attendant complications, including bleeding, infection, and organ infiltration. Chromosomal abnormalities remain the most powerful predictors of AML prognosis and help to identify a subgroup with favorable prognosis. However, the majority of AML patients who are not in the favorable category succumb to the disease. Therefore, better efforts to identify those patients who may benefit from more aggressive and investigational therapeutic approaches are needed. Newer molecular markers aim at better characterizing the large group of intermediate-risk patients and to identify newer targets for therapy. A group that has seen little improvement over the years is the older AML group, usually defined as age ≥ 60. Efforts to develop less intensive but equally efficacious therapy for this vulnerable population are underway.

Atg7 suppression enhances chemotherapeutic agent sensitivity and overcomes stroma-mediated chemoresistance in acute myeloid leukemia

“…1 Even though the majority of these patients achieve remission, disease relapse is frequent within the first year following treatment. 2 As notion of that, the persistence of minimal residual disease (MRD) is involved in disease relapse. 3 Hence, a better understanding of survival mechanisms of AML cells, including the protection rendered by their microenvironment during chemotherapy, is critical for improving the depth and the quality of response to agents used in frontline therapy.…”

Evaluation of Ykl-40 as a Prognostic Marker in Adult Acute Myeloid Leukemia Patients.

“…(20) It is the most common acute leukemia among adults and its incidence increases with age. (21) Despite the advancement in treatment options for AML, its prognosis is very variable, ranging from survival of few days to cure.…”

How I treat older patients with acute myeloid leukemia

“…Sadly, this leaves the patients who are aged >80 years and considered unfit unrepresented, and further complicates the application of clinical trial data to the individual patient. In the early 1990s, high AML induction mortality in the elderly became a focus and led to investigations into lower intensity therapies, recognizing that some older adults should be treated differently from fit younger adults . Furthermore, chronological age cannot adequately account for the variety of factors, including physical fitness, medical comorbidities, and cognitive function, that appear to significantly impact an individual's ability to tolerate induction and consolidation therapy …”

“…In the early 1990s, high AML induction mortality in the elderly became a focus and led to investigations into lower intensity therapies, recognizing that some older adults should be treated differently from fit younger adults. 32 Furthermore, chronological age cannot adequately account for the variety of factors, including physical fitness, medical comorbidities, and cognitive function, that appear to significantly impact an individual's ability to tolerate induction and consolidation therapy. 33 The decision to treat and how to treat AML in the elderly should not rely solely on PS and chronological age but ideally should include comprehensive assessments that define degrees of frailty and predict tolerance to treatment and the likelihood of benefiting from intensive approaches.…”