title: How I treat acute myeloid leukemia presenting with preexisting comorbidities.
abstract: Acute myeloid leukemia (AML) is a devastating disease with an incidence that progressively increases with advancing age. Currently, only ∼40% of younger and 10% of older adults are long-term survivors. If untreated, the overall prognosis of AML remains dismal. Initiation of therapy at diagnosis is usually urgent. Barriers to successful therapy for AML are the attendant toxicities directly related to chemotherapy or those associated with inevitable aplasia. Organ dysfunction often further complicates such toxicities and may even be prohibitive. There are few guidelines to manage such patients and the fear of crossing the medico-legal abyss may dominate. Such clinical scenarios provide particular challenges and require experience for optimal management. Herein, we discuss select examples of common pretreatment comorbidities, including cardiomyopathy, ischemic heart disease; chronic renal failure, with and without dialysis; hepatitis and cirrhosis; chronic pulmonary insufficiency; and cerebral vascular disease. These comorbidities usually render patients ineligible for clinical trials and enormous uncertainty regarding management reigns, often to the point of withholding definitive therapy. The scenarios described herein emphasize that with appropriate subspecialty support, many AML patients with comorbidities can undergo therapy with curative intent and achieve successful long-term outcome.
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel;
authors.forename: Yishai
authors.initials: Y
authors.lastname: Ofran
authors.affiliation: Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY; Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY; and.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Tallman
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel; Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Rowe
mesh_terms: D009202:Cardiomyopathies / Q000188:drug therapy*; D002561:Cerebrovascular Disorders / Q000188:drug therapy*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008103:Liver Cirrhosis / Q000188:drug therapy*; D008297:Male; D017202:Myocardial Ischemia / Q000188:drug therapy*; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*