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Shifting therapeutic paradigms in induction and consolidation for older adults with acute myeloid leukemia

Zuckerman, Tsilaa,b; Rowe, Jacob M.a,b,c

Current Opinion in Hematology: March 2019 - Volume 26 - Issue 2 - p 51–57
doi: 10.1097/MOH.0000000000000480
MYELOID DISEASE: Edited by Martin S. Tallman

Purpose of review As the age and life expectancy of the general population rise, the number of acute myeloid leukemia (AML) patients suitable for therapy is expected to dramatically increase. The population of older adults with AML, while already comprising the vast majority of AML patients, has not been specifically addressed in terms of unique age-related features, such as existence of comorbidities, frailty, and disease biology.

Recent findings Over the past decade, major improvements in the approach to the management of older adults with AML included: incorporation of new comorbidity scores specifically oriented to this patient population that can predict individual fitness to treatment, refined knowledge of the unique mutational landscape, and incorporating new combinations and novel agents designed to target the AML biology. Particularly, the recent exciting description of age-related clonal hematopoiesis and its evolution to AML may open new avenues for intervention prior to development of full-blown leukemia.

Summary The rising awareness of the unique biology and special needs of older adults with AML has resulted in the design of new studies aiming to target the aberrant mutations and clinical characteristics in this patient population.

aDepartment of Hematology and Bone Marrow Transplantation, Rambam Healthcare Campus

bRuth and Bruce Rappaport Faculty of Medicine, Technion, Haifa

cDepartment of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel

Correspondence to Tsila Zuckerman, MD, Department of Hematology and Bone Marrow Transplantation, Rambam Healthcare Campus, 8, Ha’Aliya Street, Haifa 3109601, Israel. Tel: +972 4 7773561; fax: +972 4 7772343; e-mail: t_zuckerman@rambam.health.gov.il

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