Initial therapy for acute myeloid leukemia in older patients: principles of care

Abstract

Older patients with acute myeloid leukemia (AML) frequently have significant comorbidities, geriatric syndromes, and high-risk leukemia that make them susceptible to high early mortality, chemotherapy-related toxicities, and poor long-term survival. The receipt of chemotherapy or hematopoietic cell transplantation is low, and the choices between intensive or low-intensity chemotherapy is often not clear. Geriatric and multidisciplinary interventions targeted to optimize functional status and improve management of comorbidities may enhance chemotherapy tolerance. Comprehensive geriatric assessment, and other integrated risk assessment models have been developed to predict the risk of chemotherapy-related toxicities and survival, and may guide therapy assignment. Development of low intensity but effective therapy is a major need. Deeper understanding of the molecular biology of AML has allowed several novel therapies to enter clinical trials in recent years. Continuation of successful collaboration between several stakeholders will be necessary to build upon the clinical and research improvements made thus far.

Keywords:

• Acute myelogenous leukemia
• geriatric
• treatment
• novel therapies

Acknowledgements

This work was supported in part by 2016-2017 Physician-Scientist Training Program Grant to Vijaya Bhatt from the College of Medicine, University of Nebraska Medical Center.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at http://10.1080/10428194.2017.1323275.

Additional information

Funding

This work was supported in part by 2016-2017 Physician-Scientist Training Program Grant to Vijaya Bhatt from the College of Medicine, University of Nebraska Medical Center.