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Blood Rev. 2017 Mar;31(2):43-62. doi: 10.1016/j.blre.2016.09.005. Epub 2016 Oct 8.

Selecting initial treatment of acute myeloid leukaemia in older adults.

Author information

1
Department of Internal Medicine, Hematology Section, Yale University School of Medicine, New Haven, CT, USA. Electronic address: Nikolai.podoltsev@yale.edu.
2
Yale Traditional Internal Medicine Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. Electronic address: maximilian.stahl@yale.edu.
3
Department of Internal Medicine, Hematology Section, Yale University School of Medicine, New Haven, CT, USA. Electronic address: Amer.zeidan@yale.edu.
4
Department of Internal Medicine, Hematology Section, Yale University School of Medicine, New Haven, CT, USA. Electronic address: Steven.gore@yale.edu.

Abstract

More than half of the patients with acute myeloid leukaemia (AML) are older than 60years. The treatment outcomes in this group remain poor with a median overall survival of <1year. Selecting initial treatment for these patients involves an assessment of 'fitness' for induction chemotherapy. This is done based on patient and disease-related characteristics which help to estimate treatment-related mortality and chance of complete remission with induction chemotherapy. If the risk of treatment-related mortality is high and/or the likelihood of a patient achieving a complete remission is low, lower-intensity treatment (low-dose cytarabine, decitabine and azacitidine) should be discussed. As outcomes in both groups of patients remain poor, enrolment into clinical trials of novel agents with varying mechanisms of action should be considered for all older adults with AML. Novel agents in Phase III development include CPX-351, guadecitabine (SGI-110), quizartinib, crenolanib, sapacitabine, vosaroxin and volasertib.

KEYWORDS:

AML; Clinical trial; Induction chemotherapy; Older adults; Treatment

PMID:
27745715
DOI:
10.1016/j.blre.2016.09.005
[Indexed for MEDLINE]

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