Emerging strategies for the treatment of older patients with acute myeloid leukemia.
Acute myeloid leukemia (AML) is the most common acute leukemia in adults, and its incidence increases with age. Clinical outcomes in younger patients have improved over the years but, unfortunately, there is little evidence for an equivalent improvement in outcome for older patients. Approximately 50 % of older patients who are able to receive intensive chemotherapy will achieve a complete remission; however, they face a much higher relapse rate than younger patients, and survival rates for this group are low. Therefore, there is an urgent need to improve outcomes in older patients with AML. In this article, we discuss current treatment paradigms for older patients with AML including the challenges faced when determining which patients are eligible for intensive chemotherapy. We then highlight new treatments in development that may benefit this patient group. Cytotoxic agents, hypomethylating agents, molecularly targeted agents, and cell cycle kinase inhibitors are discussed, with a focus on novel agents that have achieved an advanced stage of development. Overall, the treatment of AML in older patients remains a challenge and, whenever possible, treatment should be offered in the context of clinical trials and should be planned with curative intent.
Hematology Department, Valencia University Medical School, Hospital Universitari i Politècnic La Fe, Avinguda Fernando Abril Martorell, 106, Valencia, 46026, Spain. msanz@uv.es.|Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain. msanz@uv.es.
Miguel A
MA
Sanz
Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Gloria
G
Iacoboni
Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Pau
P
Montesinos
Department of Hematology, Tor Vergata University Hospital, Viale Oxford 81, 00133, Rome, Italy.
Adriano
A
Venditti
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003603:Cytotoxins / Q000627:therapeutic use; D019468:Disease Management; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009363:Neoplasm Proteins / Q000037:antagonists & inhibitors; D011379:Prognosis; D012307:Risk Factors; D035703:Therapies, Investigational; D059005:Topoisomerase II Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D018906:Antineoplastic Agents, Alkylating; D003603:Cytotoxins; D004791:Enzyme Inhibitors; D009363:Neoplasm Proteins; D059005:Topoisomerase II Inhibitors
Acute myeloid leukemia; Low-intensity therapy; Novel agents; Older patients; Targeted therapy