HEMATOLOGIC MALIGNANCIES: Edited by Miguel A. SanzA precision medicine approach to management of acute myeloid leukemia in older adultsUpadhyay Banskota, Shristia; Khanal, Nabinb; Bhatt, Vijaya Rajc,dAuthor Information aDepartment of Internal Medicine, Cook County Health, Chicago, Illinois bFranciscan Physician Network Oncology & Hematology Specialists, St Francis hospital, Indianapolis, Indiana cDivision of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska dFred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, USA Correspondence to Vijaya Raj Bhatt, MBBS, Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, 986840 Nebraska Medical Center, Omaha, NE 68198-6840, USA. Tel: +1 402 559 5520; fax: +1 402 559 6520; e-mail: [email protected] Current Opinion in Oncology: November 2020 - Volume 32 - Issue 6 - p 650-655 doi: 10.1097/CCO.0000000000000673 Buy Metrics Abstract Purpose of review Therapy selection in older adults with acute myeloid leukemia (AML) can be challenging because of a higher incidence of high-risk cytogenetic and molecular features conferring chemoresistance and poor functional status leading to increased treatment-related toxicities. The purpose of this review is to highlight the recent advances in precision medicine in AML that have shown promise to improve outcomes of older adults. Recent findings The utilization of next generation sequencing to identify and target actionable mutations can influence therapy selection in one-third of patients and can result in higher response rates as well as survival compared with those who do not receive targeted therapy. Oral targeted agents are available for AML with IDH 1, IDH2, or FLT3 mutations. Low-intensity venetoclax-based regimens have shown high rates of responses in AML, particularly among those with NPM1 and IDH2 mutations; responses are often durable and associated with minimal residual disease (MRD) negativity. Multiple studies have demonstrated the prognostic significance of flow cytometric MRD, with potential implications for subsequent therapy. Summary Novel approaches for AML risk-stratification, MRD assessment, and a precision medicine approach offer significant promise to improve survival and quality of life of older adults. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.