About this Series

Acute myeloid leukemia (AML) is largely a disease of older adults. The median age of patients at the time of diagnosis is 68 years, meaning that more than half are in their 70s and 80s. With aging come impaired functional status and increased comorbidities that limit treatment options in this often aggressive disease. Standard induction chemotherapy (7 + 3) and allogeneic hematopoietic stem cell transplantation, both potentially curative in AML patients, are often viewed as too intensive for elderly AML patients, which may help to explain why data have shown that over 40% of older AML patients get no treatment whatsoever.

Yet, treatment paradigms have shifted dramatically for older AML patients. The understanding of the biology of AML has led to the development of targeted therapies that can much more directly attack the cancer and provide fewer side effects. Low-dose therapies, targeted agents combined with less intensive chemotherapy, single-agent targeted therapies, and improved supportive care have greatly expanded the therapeutic strategies for elderly AML patients. This range of treatment options allows for a management strategy individualized to a patient's physical condition and therapeutic goals.

Hematologist-oncologists at Duke Cancer Institute in Durham, North Carolina, discuss the benefits of therapy for the great majority of older AML patients, the factors influencing the determination of appropriate treatment, and the expanded treatment options provided by numerous targeted therapies and less intensive chemotherapies that combine for durable remissions, improved quality of life, and highly individualized treatment plans.

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