Treating acute myeloid leukemia in older adults

Abstract

Acute myeloid leukemia (AML) is a disease of older adults, with a median age of 67 years at presentation. In the past, only a third of older patients (defined as individuals older than 60-65 years of age) with AML received definitive therapy for their disease due to concerns about their overall fitness and potential treatment-related mortality. However, compelling epidemiological data have shown unequivocally that older AML patients up to 80 years old both tolerate and survive longer after therapy than their untreated counterparts. Current therapeutic options for elderly individuals with AML include intensive chemotherapy with a cytarabine and anthracycline backbone, hypomethylating agents (decitabine and azacitidine), low-dose cytarabine, investigational agents, and supportive care with hydroxyurea and transfusions. Over the last few years, there has been increasing debate regarding the appropriate therapeutic approach to take in older adults given the diversity of the geriatric patient population and heterogeneous AML disease biology. This article discusses how performance status, comorbidities, disease characteristics, quality of life concerns, and long-term treatment goals affect the selection of appropriate therapy for older adults with AML. Risks and benefits of each treatment approach based on the most recent medical literature are discussed. Finally, a treatment algorithm summarizing these data and incorporating geriatric assessment and molecular and cytogenetic markers predictive of therapeutic response is proposed to aid in the clinical decision-making process. Learning Objective• To identify appropriate therapeutic strategies for the older patient with AML, taking into consideration the patient's performance status, comorbidities, disease characteristics, and goals

Targeting sphingosine kinase 1 induces MCL1-dependent cell death in acute myeloid leukemia

“…Titration of MP-A08 with cytarabine, a pyrimidine nucleoside analog widely employed in standard induction chemotherapy for AML, 37 resulted in synergistic cell death in both primary AML blasts ( Figure 3A) and LSPCs ( Figure 3B) (CI ,1.0 and fractional product method with values , 20.1). 38,39 To validate these findings, we employed a doxycyclineinducible lentiviral system to manipulate SPHK1 expression in MV4-11 cells.…”

Azacitidine in the treatment of older patients affected by acute myeloid leukemia: A report by the Rete Ematologica Pugliese (REP)

“…The prognosis of elderly AML patients is well known to be very poor, with a median survival of 3 months, a high incidence of 8-week mortality, and <10% survival at 2 years [23,24]. Therefore, for patients unfit to receive standard chemotherapy (like our study population), alternative therapies that could obtain complete remission (CR) might prolong survival while preserving the quality of life [25][26][27][28] .…”

Ringsideroblaster

“…Livskvaliteten hos de som oppnår remisjon er klart bedret. På bakrgunn av slike data er det en økende tendens til å tilby også eldre intensiv induksjonsbehandling (30). Ulike indekser for funksjonsnivå, komorbiditet og sykdomsrelaterte faktorer, kan til en viss grad identifisere grupper av pasienter som kan ha økt tidlig mortalitet (28;31-33 ) ikke aktuelt pga høy risiko for behandlingsrelatert toksisitet og død.…”