Acute Myelogenous Leukemia in Older Adults

Learning Objectives Outline the influences of tumor biology on clinical outcomes in older adults with acute myelogenous leukemia (AML). Enumerate patient‐specific characteristics that influence clinical outcomes for older adults with AML. Formulate an algorithm to guide treatment decisions for older adults with newly‐diagnosed AML. This article is available for continuing medical education credit at CME.TheOncologist.com. The incidence of acute myelogenous leukemia (AML) increases with age. Older AML patients, generally defined by age ≥60 years, have worse treatment outcomes than younger patients. While selected older patients can benefit from standard therapies, as a group they experience greater treatment‐related toxicity, lower remission rates, shorter disease‐free survival times, and shorter overall survival times. Outcome disparity is in part explained by age‐related biologic features. Older patients are more likely to present with unfavorable cytogenetic abnormalities, multidrug resistance phenotypes, and secondary AML. However, even older adults with favorable tumor biology have a worse prognosis than younger patients. Patient‐specific factors, including impaired physical function and comorbidity, independently predict greater treatment toxicity and shorter survival. Improving patient assessment strategies is critical to identify those patients who are most likely to benefit from induction and postremission therapies. In addition, continued efforts to identify more effective and tolerable induction and postremission strategies are needed for this population. Investigations of hypomethylating agents and signal transduction inhibitors hold promise for the treatment of AML patients. Steady advances in the field of hematopoietic transplantation, including use of reduced intensity transplants, may result in additional curative options available to selected older adults. Finally, improved supportive care strategies are needed to maximize treatment outcomes. This study investigates the treatments and outcomes of older adults with acute myelogenous leukemia. The study finds that older adults with favorable tumor biology, good functional status, and minimal comorbidity can benefit from standard induction chemotherapy and recommends that treatment decisions be individualized after careful consideration of tumor biology and patient characteristics.