Treatment of AML in First Remission in Older Adults (Aged ≥55) with Nonfavorable Prognosis
This protocol addresses older adults (aged ≥55) with acute myeloid leukemia who have achieved first remission after responding to initial antileukemic therapy. The relevant population is specifically those who are candidates for allogeneic hematopoietic stem cell transplantation and whose disease carries nonfavorable prognosis based on molecular and karyotypic characteristics.
Clinical Scenario
The patient is an older adult (≥55 years) with AML in first complete remission. The features that define this protocol:
Treatment Approach
For this population, the recommended approach involves a transplantation-based strategy pursued during first remission rather than no transplantation — the full protocol details the specific recommendation, its certainty rating, and the supporting evidence.
Clinical Goal
The primary objective is decreased recurrence of leukemia.
References
DOI: 10.1182/bloodadvances.2025017934
For older adults with newly diagnosed AML who have responded to initial ALT, who are candidates for an allo-HCT during first remission, and who have nonfavorable prognosis based on molecular and karyotypic characteristics, the ASH guideline panel suggests an allo-HCT over no transplantation (conditional recommendation based on very low certainty in the evidence of effects ⨁◯◯◯)
Allo-HCT may also decrease recurrence at 12 months (RR, 0.75; 95% CI, 0.56-1.01; very low certainty in evidence) and at longest follow-up (RR, 0.63; 95% CI, 0.51-0.79; 60 months follow-up; very low certainty in evidence).
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