Advancements in the management of medically less-fit and older adults with newly diagnosed acute myeloid leukemia. Expert Opin Pharmacother 2018 Jun;19(8):865-882
Date
04/27/2018Pubmed ID
29697000DOI
10.1080/14656566.2018.1465562Scopus ID
2-s2.0-85047964670 (requires institutional sign-in at Scopus site) 14 CitationsAbstract
INTRODUCTION: Treating acute myeloid leukemia (AML) in older adults remains daunting. The unique biology often renders conventional chemotherapies less effective. Accurately predicting the toxicities of treatment is another unresolved challenge. Treatment planning thus requires a good knowledge of the current trial data and familiarity with clinical tools, including formal fitness and geriatric assessments. Both obstacles - disease biology and patient fitness - might be easier overcome with specific, AML cell-targeted agents rather than traditional cytotoxic chemotherapy. This may be the future of AML therapy, but it is not our current state.
AREAS COVERED: Herein, the authors appraise the data supporting a standard induction approach, including an outline of how to predict treatment-related mortality and a review of the most up-to-date methods of geriatric assessment. They also discuss treatment expectations with less-intense therapies and highlight novel agents in development. Finally, they provide a basic approach to choosing treatment intensity.
EXPERT OPINION: In an older and/or medically less-fit patient, treatment choice should begin with a thorough disease assessment, a formal evaluation of patient fitness and frailty. There should also be a clear communication with the patient and patient's family about the risks and anticipated benefits of either an intense or nonintense treatment approach.
Author List
Michaelis LC, Klepin HD, Walter RBAuthor
Laura Michaelis MD Chief, Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAntineoplastic Agents
Drug Therapy, Combination
Geriatric Assessment
Hematopoietic Stem Cell Transplantation
Humans
Leukemia, Myeloid, Acute
Protein Kinase Inhibitors
Quality of Life