Treatment of newly diagnosed AML in older adults: ASH Guideline

Key recommendations include:

• 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.
• For older adults with newly diagnosed AML considered candidates for intensive antileukemic therapy, the ASH guideline panelsuggests intensive antileukemic therapy over less-intensive antileukemic therapy.
• 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 suggestspostremission therapy over no additional therapy.
• 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.
• 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.
• For older adults with AML who achieve a response after receiving less-intensive therapy, the ASH guideline panel suggestscontinuing therapy indefinitely until progression or unacceptable toxicity over stopping therapy.
• 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. There may be rare instances where platelet transfusions may be of benefit in the event of bleeding, but there are even less data to support this practice and it is anticipated that platelet transfusions will have little or no role in end-of-life or hospice care.