Treating Newly Diagnosed Acute Myeloid Leukemia in Older Adults
Publication Date: August 6, 2020
Recommendations
For older adults with newly diagnosed AML who are candidates for such therapy, the American Society of Hematology (ASH) guideline panel recommends offering antileukemic therapy over best supportive care. (StrongModerate)
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For older adults with newly diagnosed AML considered candidates for intensive antileukemic therapy, the ASH guideline panel suggests intensive antileukemic therapy over less-intensive antileukemic therapy. (ConditionalLow)
607
For older adults with AML who achieve remission after at least a single cycle of intensive antileukemic therapy and who are not candidates for allogeneic hematopoietic stem cell transplantation (HSCT; allo-HSCT), the ASH guideline panel suggests postremission therapy over no additional therapy. (ConditionalLow)
Remarks: In some settings, patients may receive 2 cycles of intensive antileukemic therapy even if they achieve remission after the first one. In those settings, the panel considered the second cycle of intensive therapy to be postremission therapy.
607
For older adults with AML considered appropriate for antileukemic therapy but not for intensive antileukemic therapy, the ASH guideline panel suggests using either of the options when choosing between hypomethylating-agent monotherapy and low-dose-cytarabine monotherapy. (ConditionalModerate)
607
For older adults with AML considered appropriate for antileukemic therapy (such as hypomethylating agents [azacitidine and decitabine] or low-dose cytarabine) but not for intensive antileukemic therapy, the ASH guideline panel suggests using monotherapy with 1 of these drugs over a combination of 1 of these drugs with other agents. (ConditionalLow)
Remarks: For patients treated with combination therapy, the agents for which there is evidence of effectiveness are low-dose cytarabine in combination with glasdegib, based on a small randomized trial, and hypomethylating agents or low-dose cytarabine in combination with venetoclax, based on promising data from phase 2 trials. These recommendations may change (favoring combination therapies over monotherapy) with upcoming reporting of results from randomized trials.
607
For older adults with AML who achieve a response after receiving less-intensive therapy, the ASH guideline panel suggests continuing therapy indefinitely until progression or unacceptable toxicity over stopping therapy. (ConditionalVery Low)
607
For older adults with AML who are no longer receiving antileukemic therapy (including those receiving end-of-life care or hospice care), the ASH guideline panel suggests having red blood cell (RBC) transfusions be available over not having transfusions be available. (ConditionalVery Low)
There may be rare instances where platelet transfusions may be of benefit in the event of bleeding, but there are even less data to support this practice and it is anticipated that platelet transfusions will have little or no role in end-of-life or hospice care.
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Title
Treating Newly Diagnosed Acute Myeloid Leukemia in Older Adults
Authoring Organization
American Society of Hematology
Publication Month/Year
August 6, 2020
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Male, Female, Older adult
Health Care Settings
Ambulatory, Hospital, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Treatment, Management
Diseases/Conditions (MeSH)
D007938 - Leukemia, D015470 - Leukemia, Myeloid, Acute, D007951 - Leukemia, Myeloid
Keywords
AML, acute myeloid leukemia
Source Citation
Mikkael A. Sekeres, Gordon Guyatt, Gregory Abel, Shabbir Alibhai, Jessica K. Altman, Rena Buckstein, Hannah Choe, Pinkal Desai, Harry Erba, Christopher S. Hourigan, Thomas W. LeBlanc, Mark Litzow, Janet MacEachern, Laura C. Michaelis, Sudipto Mukherjee, Kristen O’Dwyer, Ashley Rosko, Richard Stone, Arnav Agarwal, L. E. Colunga-Lozano, Yaping Chang, QiuKui Hao, Romina Brignardello-Petersen; American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults. Blood Adv. 2020; 4 (15): 3528–3549. doi: https://doi.org/10.1182/bloodadvances.2020001920