AML treatment in older adults

Acute myeloid leukemia (AML) is an aggressive hematologic malignancy that affects people of all ages but becomes more common with increasing age. The median age at diagnosis is 67 years, and nearly 1/3 of patients are ≥75 years old at diagnosis [1]. However, successful treatment of AML in older patients (typically defined as >60 years in those with AML) presents a significant challenge due to poor tolerance of the standard chemotherapy and adverse biological features of the leukemic cells compared to younger patients. Older patients are more likely to have adverse cytogenetic features, antecedent hematologic disorders that predispose to chemotherapy resistance, and a higher expression of multidrug resistance genes. Furthermore, their increased frequency of comorbidities and decreased performance status at the time of diagnosis leads to poorer tolerance to therapy compared to younger patients. Combined, these features lead to a 5-year leukemia free survival of only 8.5% older adults (age 65-74) compared to 39% in those under age 65 [2].