Abstract
Acute myeloid leukemia (AML) is a heterogeneous aggressive hematologic malignancy derived from malignant clones that promote their own growth and survival at the expense of normal hematopoiesis resulting in life-threatening bleeding and infections. Traditional initial AML therapy has been centered on a backbone of intensive chemotherapy often composed of an anthracycline and cytarabine. This strategy has proven most effective in patients less than 60 years of age due to both patient-related tolerability factors as well as changes in AML biology centered on chemotherapy refractory mutational profiles that are seen with advancing age. Recent improvements in frontline AML therapy have been seen in patients 60 years of age and over, a population most typically referred to as “older” adult AML. Herein, we describe the characteristics of “older” adult AML, review the differences in outcomes amongst those 60–75 and those over 75 years of age, and cite challenges in delivering frontline therapies within this group based not only on therapeutic toxicity but also on the patient’s overall level of “fitness” and inherent biology. We also discuss the role of targeted therapies that inhibit specific mutations and have the potential to deliver improved efficacy with less side effects while also recognizing that some selected older AML patients still benefit from intensive induction therapy.
Highlights
Academic Editors: Ugo Testa and Roland B
We discuss the role of targeted therapies that inhibit specific mutations and have the potential to deliver improved efficacy with less side effects while recognizing that some selected older Acute myeloid leukemia (AML) patients still benefit from intensive induction therapy
Later analyses of this study found that patients with a normal karyotype, core-binding factor (CBF), and those with RAS-mutated, non-CBF AML had a lower incidence of relapse with HIDAC [87,88]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Acute myeloid leukemia (AML) is an aggressive hematologic malignancy affecting about 0.5% of people in their lifetime. Over the last few decades, a growing understanding of AML has revealed it to be a heterogenous disease with a widely variable prognosis. This is largely driven by disease biology, the ability to tolerate highly toxic multi-agent chemotherapy and, in most cases, undergo allogeneic stem cell transplantation to be cured of disease. Our review will focus on the characteristics of AML in “older” patients and discuss frontline management approaches for this population that can range in terms of performance status from “fit” to medically “frail”. We discuss future directions for treatment in this disproportionately afflicted, vulnerable population
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