ASH releases guidelines on Acute Myeloid Leukemia in Older Adults

Each year, nearly 20,000 people receive a diagnosis of AML. The disease generally develops in older people; the median age of diagnosis is 68. AML prognosis in older adults is poor. In fact, on average, a 75-year-old diagnosed with AML usually has a life expectancy measured in just months.

The American Society of Hematology 2020 Guidelines are guided by the principle that throughout a patient's disease course, optimal care involves ongoing discussions between clinicians and patients, continuously addressing goals of care and the relative risk-benefit balance of treatment.

"These guidelines take providers through the conversations they have with newly diagnosed patients, almost in real-time," said Mikkael Sekeres, MD, chair of the ASH AML guideline panel and director of the Leukemia Program at Cleveland Clinic Taussig Cancer Institute. "A discussion between patient and physician is instrumental to creating a personalized treatment plan, and these guidelines are unique in that they keep a patient's goals and wishes front and center in that conversation."

In addition to the paucity of curative treatment options and high prevalence of comorbidities complicating treatment in this patient population, some providers may be reluctant to recommend intensive therapies, or any therapy at all, because they fear toxicities in older patients. And some patients may not wish to spend their valuable remaining time in the hospital.

"We recognize the serious issues that patients face, including the side effects and risks of chemotherapy and time in the hospital. Weighing these issues against possible benefits, including remission and extended life, patients can decide what treatment is consistent with their goals," said Dr. Sekeres.

Many hospice organizations will not allow patients to receive blood product transfusions, often for economic reasons. For AML patients in end-of-life and hospice care, the guidelines recommend that blood transfusions should be considered standard supportive care, as they can address palliative needs related to breathlessness, bleeding, and profound fatigue, as well as improve overall quality of life. This guidance supports an ASH policy statement in support of ensuring Medicare hospice beneficiaries can access palliative transfusions.

The AML guidelines are the most recent product of a larger guideline development initiative for ASH, which includes a commitment to the timely update of existing guidelines and the development of new ones on a range of hematologic conditions. In the coming months, resources to aid in the implementation of the guidelines will be added to the ASH website.

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