The American Society of Hematology (ASH) released a guideline update late last year for its Treating Newly Diagnosed Acute Myeloid Leukemia in Older Adults guideline. Released in November 2025, the guideline replaces the previous version released in August 2020. Featuring 16 recommendations, up from seven in the 2020 version, these guidelines reflect the latest review of evidence conducted.
The 2025 guideline updates focus on treatment compared to best supportive management, the role and duration of post-remission therapy, the use of targeted therapy, the role of hematopoietic stem cell transplantation in non-favorable diagnosis, the role of transfusion support for patients no longer receiving antileukemic therapy, and more. Below you can find a comparison table of the recommendations from the 2020 guideline and the 2025 guideline, as well as links to view the full-text versions of both.
Guidelines Referenced:
Treating Newly Diagnosed Acute Myeloid Leukemia in Older Adults
Treating Newly Diagnosed Acute Myeloid Leukemia in Older Adults
- Published: August 2020
- Full Text
Major Changes and Key Takeaways (2020-2026)
There are two recommendations in the 2025 update that remain the same, aligning with the 2020 recommendations. Those two recommendations are recommendation 1 in both guidelines and recommendation 9 (which aligns with recommendation 6 in the 2020 guideline).
Notably, the 2025 guideline features more recommendations, including expansions on several existing recommendations. For example, 2020’s recommendation 2 was transformed into recommendations 2A and 2B. Recommendations 7 and 8 were also added to discuss older adults with newly diagnosed AML with unique variables for consideration.
The following table reflects the new recommendations added in the 2025 update. To view the complete guideline, along with the accompanying summaries of evidence, view the full-text versions using the links featured above.
| Topic | 2020 Guideline | 2026 Guideline |
|---|---|---|
| Antileukemic Therapy vs. Best Supportive Care | 1. 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. | 1. For older adults with newly diagnosed AML who are candidates for antileukemic therapy, the American Society of Hematology guideline panel recommends offering antileukemic therapy over best supportive care. |
| Older Adults w/ Newly Diagnosed AML Considered Candidates For Intensive Antileukemic Therapy | 2. 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. | 2A. For older adults with newly diagnosed AML considered candidates for intensive antileukemic therapy, the ASH guideline panel suggests conventional induction and post-remission therapy over HMA or LDAC monotherapy induction and post-remission therapy. 2B. For older adults with newly diagnosed AML considered candidates for intensive antileukemic therapy, the ASH guideline panel suggests using either conventional induction and post-remission therapy or HMA or LDAC-based induction and post-remission therapy in combination with venetoclax. |
| Older Adults w/ AML Who Achieve Remission After At Least a Single Cycle of Intensive Antileukemic Therapy and Who Are Not Candidates For Allogeneic HSCT | 3. 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. | 3. For older adults with AML who achieve remission after at least a single cycle of conventional induction therapy and who are not candidates for allogeneic hematopoietic stem cell transplantation (HCT; allo-HCT), the ASH guideline panel recommends post-remission therapy over no additional therapy. |
| Older Adults w/ AML Considered Appropriate For Antileukemic Therapy But Not For Intensive Antileukemic Therapy | 4A. 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. 4B. 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. | 4A. For older adults with newly diagnosed AML considered appropriate for antileukemic therapy but not for conventional induction and post-remission therapy or for HMA based combination therapy, the ASH guideline panel suggests azacitidine monotherapy over LDAC monotherapy. 4B. For older adults with newly diagnosed AML considered appropriate for antileukemic therapy but not for conventional induction and post-remission therapy or for HMA-based combination therapy, the ASH guideline panel suggests 5-d decitabine monotherapy over 10-d decitabine monotherapy. 4C. For older adults with newly diagnosed AML considered appropriate for antileukemic therapy but not for conventional induction and post-remission therapy, the ASH guideline panel suggests HMA in combination with venetoclax over HMA alone. 4D. For older adults with newly diagnosed AML considered appropriate for antileukemic therapy but not for conventional induction and post-remission therapy or for HMA based combination therapy, the ASH guideline panel suggests LDAC in combination with venetoclax over LDAC monotherapy. |
| For Older Adults w/ Newly Diagnosed AML and an IDH1 Mutation Considered Appropriate for Antileukemic Therapy But Not For Conventional Induction and Post-Remission Therapy | N/A | 5A. For older adults with newly diagnosed AML and an IDH1 mutation considered appropriate for antileukemic therapy but not for conventional induction and post-remission therapy, the ASH guideline panel suggests azacitidine in combination with ivosidenib over azacitidine monotherapy. 5B. For older adults with newly diagnosed AML and an IDH1 mutation considered appropriate for antileukemic therapy but not for conventional induction and post-remission therapy, the ASH guideline panel suggests using either HMA in combination with ivosidenib or HMA in combination with venetoclax. 5C. For older adults with newly diagnosed AML and an IDH2 mutation considered appropriate for antileukemic therapy but not for conventional induction and post-remission therapy, the ASH guideline panel suggests azacitidine monotherapy over azacitidine in combination with enasidenib. 5D. For older adults with newly diagnosed AML and an IDH2 mutation considered appropriate for antileukemic therapy but not for conventional induction and post-remission therapy, the ASH guideline panel suggests HMA in combination with venetoclax over HMA in combination with enasidenib. |
| For Older Adults w/ AML Who Achieve a Response | 5. 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. | 6. For older adults with AML who achieve a response after receiving HMA- or LDAC-based induction and post-remission therapy, the ASH guideline panel suggests continuing therapy indefinitely until progression or unacceptable toxicity over stopping therapy after a finite number of cycles. |
| Older Adults w/ Newly Diagnosed AML Who Have a FLT3 Mutation | N/A | 7. For older adults with newly diagnosed AML who have a FLT3 mutation, the ASH guideline panel suggests antileukemic therapy in combination with a FLT3 inhibitor over antileukemic therapy alone. |
| Older Adults w/ Newly Diagnosed AML Who Have Responded to Initial Antileukemic Therapy, Who Are Candidates for an Allo-HCT During First Remission, and Who Have Non-Favorable Prognosis Based on Karyotypic and Molecular Characteristics | N/A | 8. For older adults with newly diagnosed AML who have responded to initial antileukemic therapy, who are candidates for an allo-HCT during first remission, and who have non-favorable prognosis based on karyotypic and molecular characteristics, the ASH guideline panel suggests an allo-HCT over no transplantation. |
| Older Adults w/ AML Who Are No Longer Receiving Antileukemic Therapy | 6. 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. | 9. 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. |
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