title: Selecting initial treatment of acute myeloid leukaemia in older adults.
abstract: More than half of the patients with acute myeloid leukaemia (AML) are older than 60years. The treatment outcomes in this group remain poor with a median overall survival of <1year. Selecting initial treatment for these patients involves an assessment of 'fitness' for induction chemotherapy. This is done based on patient and disease-related characteristics which help to estimate treatment-related mortality and chance of complete remission with induction chemotherapy. If the risk of treatment-related mortality is high and/or the likelihood of a patient achieving a complete remission is low, lower-intensity treatment (low-dose cytarabine, decitabine and azacitidine) should be discussed. As outcomes in both groups of patients remain poor, enrolment into clinical trials of novel agents with varying mechanisms of action should be considered for all older adults with AML. Novel agents in Phase III development include CPX-351, guadecitabine (SGI-110), quizartinib, crenolanib, sapacitabine, vosaroxin and volasertib.
authors.affiliation: Department of Internal Medicine, Hematology Section, Yale University School of Medicine, New Haven, CT, USA. Electronic address: Nikolai.podoltsev@yale.edu.
authors.forename: Nikolai A
authors.initials: NA
authors.lastname: Podoltsev
authors.affiliation: Yale Traditional Internal Medicine Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. Electronic address: maximilian.stahl@yale.edu.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Stahl
authors.affiliation: Department of Internal Medicine, Hematology Section, Yale University School of Medicine, New Haven, CT, USA. Electronic address: Amer.zeidan@yale.edu.
authors.forename: Amer M
authors.initials: AM
authors.lastname: Zeidan
authors.affiliation: Department of Internal Medicine, Hematology Section, Yale University School of Medicine, New Haven, CT, USA. Electronic address: Steven.gore@yale.edu.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Gore
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000066491:Clinical Decision-Making; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D019468:Disease Management; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D016896:Treatment Outcome
keywords: AML; Clinical trial; Induction chemotherapy; Older adults; Treatment