Acute myeloid leukemia
ICD-10 C92.0 · ICD-11 2A60

Treatment of Newly Diagnosed AML in Patients Aged ≥75 or Not Eligible for Intensive Induction

Clinical scenario

This protocol covers newly diagnosed acute myeloid leukaemia in patients who are not candidates for intensive induction chemotherapy — specifically those aged ≥75 years, with an ECOG performance score of ≥3, or with pre-existing heart, kidney, lung, or liver disease.

Why intensive induction is not appropriate

Age ≥75 years, an ECOG performance score of 3, and pre-existing cardiac, renal, pulmonary, or hepatic disease are among the strongest predictors of non-relapse induction-related mortality. These factors are used to determine that a patient is ineligible for intensive induction and consolidation chemotherapy.

Treatment approach (partial overview): In this population, a hypomethylating agent (HMA) is the preferred first-line choice. An alternative agent may be considered in selected patients, with important exceptions depending on cytogenetic risk profile. Specific agent selection, scheduling details, and the full decision algorithm are available in the complete protocol below.
Clinical goals

Response and clinical benefit should be evaluated after a minimum of 4 treatment cycles. Continuation depends on documented benefit; therapy may be stopped after at least 4 consecutive cycles if no response or clinical benefit has been achieved.

Instant Access to Structured Evidence-Based Regimens

References

  1. Pre-existing heart, kidney, lung or liver disease, mental illness, an Eastern Cooperative Oncology Group (ECOG) performance score 3 and age 75 years are the strongest predictors for nonrelapse induction-related mortality and should be considered to determine ineligibility to intensive induction and consolidation ChT [V, B].
  2. The HMAs azacitidine and decitabine are currently the first choice in newly diagnosed unfit AML patients [II, B].
  3. Thus, if decitabine is chosen, it is recommended to follow the 5-day schedule [II, B].
  4. Given the moderate effects of HMAs, LDAC remains an alternative to HMAs in the first-line treatment of AML patients who are ineligible for standard induction and consolidation ChT, except in patients with adverse-risk cytogenetics, where LDAC has very poor activity [II, B].
  5. In patients treated nonintensively, response should be assessed at the very least after 4 cycles to diagnose refractory disease, and every 3 months thereafter if patients have no or incomplete recovery of at least one of the three blood lineages to identify refractory disease.
  6. HMA treatment is usually continued until disease progression or intolerance but may be terminated after at least 4 consecutive cycles if the patient has not responded or derived clinical benefit.
View source ↗