In this review, the authors argue that the current treatment algorithm for older patients with acute myeloid leukemia (AML) ─ induction, followed by consolidation (with or without transplantation) versus hospice ─ is no longer sufficient. Instead, they put forth a new treatment algorithm that includes broad, panel-based genetic assessment, a focus on modifiable patient-related factors, and assessments of the improved supportive care now available to older patients with AML.
Using 3 case studies, a literature review and emerging new treatment choices for AML, the authors discuss risk-stratification in older patients with AML, focusing on disease- and patient-related factors.
Disease-related factors discussed include the updated classifications of cytogenetic abnormalities based on broad panel-based mutational analyses recommended by the National Comprehensive Cancer Network (NCCN) and European LeukemiaNet (ELN).
Patient-related factors that affect the decision to treat, beyond chronological age, include physical fitness, medical comorbidities, and cognitive function. Use of an updated treatment algorithm and consideration of the unique circumstances for each patient should be incorporated into the treatment plan.
The authors conclude by noting that along with pharmaceutical and hospital-based interventions, support from family and skilled providers (nursing, physical therapy, occupational therapy, home health aides, nutritionists, and transportation) is essential to developing a comprehensive treatment plan for older patients with AML.