Validation of SIE/SIES/GITMO consensus criteria for unfitness to predict early mortality and survival in acute myeloid leukaemia patients treated with hypomethylating agents and venetoclax

Latest Insights and Progress in the Clinical Management of Elderly Patients with Acute Myeloid Leukemia: From Genetic Advancements to Targeted Treatments

“…While outcomes have improved through novel therapies [43,45,57], a better understanding of toxicities, and advances in allogeneic SCT [88], the long-term OS remains poor, especially for older patients [5,45,47,50]. With this regard, it is essential to assess the patient's fitness [83,[85][86][87] and to stay updated on the latest treatments [92]. Moreover, a critical step is performing diagnostic tests that allow the detection of baseline mutations and monitoring changes at relapse.…”

“…The AML outcome in older patients depends on age, overall health, and fitness status. Managing AML in older patients is difficult due to decreased functional abilities and individual fitness [5,46,[85][86][87]. As a result, most older patients with AML are not suitable for ICT, are more likely to have genetic features with negative prognostic impact as well as may be resistant to treatments.…”

“…As a result, most older patients with AML are not suitable for ICT, are more likely to have genetic features with negative prognostic impact as well as may be resistant to treatments. In the last two decades, several efforts have provided appropriate tools to determine which patients are fit or unfit for ICT or non-ICT in clinical practice [83,86,87]. However, recent progress in understanding the genetic factors affecting AML outcomes has expanded treatment options for older patients, including targeted and lower-intensity therapies (Tale 3) [45][46][47][48][49][50] in both frontline and relapsed/refractory (R/R) settings [88,89].…”

“…In contrast, a reduction of ICT from 40% to 18% and HMA alone from 19% to 13%, respectively, was recorded [92]. Although the "Ferrara criteria" have been validated in this setting by a retrospective study [87], proposals for updating the treatment-specific fitness criteria in the context of venetoclax/HMA, due to the unique toxicity profile of this treatment combination, inducing prolonged neutropenia and increased risk of infections. In particular, an age limit of 80-85, a cardiac function > 40%, the absence of certain lung conditions, and an adequate caregiver should be essential to update fitness criteria for patients to evaluate for venetoclax/HMA combination treatment [92].…”