Advances in the management of acute myeloid leukemia in older adult patients.
OBJECTIVE
To update oncology nurses on new developments in the care of older adult patients with acute myeloid leukemia (AML).


METHODS
Clinical trial data, published guidelines, review articles, and conference proceedings.


RESULTS
Therapies for older adult patients with AML include cytarabine-based intensive-induction chemotherapy, investigational therapy, and supportive care. Nonmyeloablative allogeneic hematopoietic stem cell transplantation may provide the best opportunity for cure following remission if a human leukocyte antigen-matched hematopoietic stem cell donor is available. Careful assessment of patient- and disease-related factors is critical in determining the appropriate treatment modality for individuals. Assessment tools and algorithms may identify patients likely to be intolerant of intensive therapies. Supportive care may improve treatment tolerance and quality of life.


CONCLUSIONS
Survival outcomes have not improved significantly for older adult patients with AML. Novel therapies, coupled with better understanding of prognostic factors, may allow more highly individualized care. Performance status or comorbidity score may provide insights regarding outcome, particularly when combined with age, cytogenetic risk, or molecular markers. Efforts to improve transplantation safety may increase use in the older adult patient population.


CONCLUSIONS
Nurses provide disease and treatment information, manage adverse effects, and offer emotional support. Knowledge of the key management issues for older adult patients with AML is critical in fulfilling this role.
Rogers
Barbara B
BB
Fox Chase Cancer Center, Philadelphia, PA, USA. barbara.rogers@fccc.edu
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001374:Azacitidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D000077209:Decitabine; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000145:classification / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D024802:Nurse's Role; D009730:Nursing Assessment; D009859:Oncology Nursing / Q000379:methods*; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011788:Quality of Life / Q000523:psychology; D012944:Social Support; D033581:Stem Cell Transplantation
D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine; D000077209:Decitabine; D001374:Azacitidine