Last updated March 15, 2022

Treating Newly Diagnosed Acute Myeloid Leukemia in Older Adults

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)
607

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.
607

Recommendation Grading

Overview

Title

Treating Newly Diagnosed Acute Myeloid Leukemia in Older Adults

Authoring Organization

Publication Month/Year

August 6, 2020

Document Type

Guideline

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