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Publications

Journal Article Consensus Statement Guideline Epublish

PubMed: 42505231 DOI: 10.3390/curroncol33070429

Management of Acute Myeloid Leukemia in Older Patients: An Updated Canadian Consensus.

Curr Oncol 33(7)

Authors: Andre C Schuh, Nicholas Chornenki, Mohamed A Elemary, Mahmoud Elsawy, Brett L Houston, Brian Leber, Lee Mozessohn, Mitchell Sabloff, Brittany Salter, David Sanford, Joseph Brandwein

Affiliations

  • Departments of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada.
  • Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
  • Division of Hematology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
  • Institute of Health Policy, Management and Evaluation Toronto, University of Toronto, ON M5T 3M6, Canada.
  • Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada.
  • Saskatoon Cancer Centre, Saskatoon, SK S7N 4H4, Canada.
  • Division of Oncology, College of Medicine, University of Saskatchewan, Hematology, Saskatoon, SK S7N 5E5, Canada.
  • Division of Hematology and Hematologic Oncology, Department of Medicine, Dalhousie University, Halifax, NS B3H 2Y9, Canada.
  • QEII Health Sciences Centre, Halifax, NS B3H 3A7, Canada.
  • Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 3P5, Canada.
  • Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada.
  • Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada.
  • Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada.
  • The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada.
  • Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada.
  • Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada.

Abstract

These are the third Canadian consensus guidelines on the management of acute myeloid leukemia (AML) in older patients. The first was published in 2013, and the second in 2017. The management of AML in older patients changed significantly over this time span, with decreasing emphasis on the use of intensive chemotherapy and the adoption of new standards of care based on less-intensive therapies: first azacitidine + venetoclax combinations, followed by azacitidine + ivosidenib. Increased use of these new therapies in older patients has raised questions about their use, including how to determine patient suitability, select the most effective therapy, and manage dosing and toxicity. In this third Canadian guideline, we address these questions to provide clarity around these new standards of care and improve clinician understanding and confidence in using them. As more new targeted agents become available and hypomethylating agent-based triplet combinations are used more widely, we fully anticipate that we will, in some years' time, write a fourth guideline on the management of AML in older patients.

MeSH

Neoplasms, Leukemia, Leukemia, Myeloid, Acute, Azacitidine, Leukemia, Myeloid, Therapeutics