Recent insights and clinical issues in acute myeloid leukemia in older adults

Abstract

Treatment for acute myeloid leukemia (AML) in older adults has traditionally focused on adjusting treatment intensity and expanding the indications for the 3+7 regimen and allogeneic stem cell transplantation. However, recent advances, particularly the introduction of venetoclax plus azacitidine, have significantly improved outcomes. New agents such as quizartinib, CPX-351, venetoclax plus low-dose cytarabine, gemtuzumab ozogamicin, and ivosidenib have also emerged. Low-intensity treatment options, especially regimens incorporating molecularly targeted agents, offer potential survival benefits for older patients. Consequently, selecting and combining these therapies with conventional treatments has become a significant challenge in clinical practice. In treatment decision-making, it is essential to utilize a comprehensive geriatric assessment, which evaluates not only disease factors but also physical and cognitive function, nutritional status, and social background. It is particularly important to identify the molecular prognostic risk signature based on genetic mutation data and apply stratification models to carefully assess disease factors. This comprehensive approach ensures a tailored treatment strategy. This article provides an overview of AML in older adults and current treatment options in Japan, as well as discusses future drug developments and necessary approaches to make informed treatment decisions.