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

Treatment of Newly Diagnosed Acute Myeloid Leukemia in Older Adults (Aged ≥55) Who Are Candidates for Intensive Therapy

This protocol covers first-line management of newly diagnosed acute myeloid leukemia in patients aged 55 years and older who are considered candidates for intensive antileukemic therapy and who carry favorable-risk cytogenetics or molecular mutations.

Clinical Scenario

Age ≥55 Older adults with newly diagnosed AML represent a population in which treatment intensity must be carefully weighed. When the patient is fit enough for intensive antileukemic therapy, cytogenetic and molecular risk stratification guides the choice of induction and postremission strategy. The presence of favorable-risk cytogenetics or molecular mutations is a key factor supporting this pathway — and is associated with particular benefit from certain induction approaches.

Conventional induction and postremission therapy may be preferred for patients with favorable-risk features, and for those for whom an extended inpatient stay is not a barrier to care.

Treatment Approach — Partial Overview

For eligible older adults, the recommended approach centers on conventional induction chemotherapy followed by postremission therapy. The guidelines also address an alternative induction strategy using a targeted combination for patients in whom conventional induction is not the preferred route. For patients who achieve remission and are not candidates for stem cell transplantation, continued postremission therapy is recommended over stopping treatment entirely.

Full regimen, complete sequencing, individualised options, and all postremission strategies are in the complete protocol →

Treatment Goals
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1182/bloodadvances.2025017934
  1. For older adults with newly diagnosed AML considered candidates for intensive ALT, the ASH guideline panel suggests conventional induction and postremission therapy over HMA or LDAC monotherapy induction and postremission therapy (conditional recommendation based on low certainty in the evidence of effects ⨁⨁◯◯).
  2. Conventional induction and postremission therapy may be preferred for patients who have favorable-risk cytogenetics or molecular mutations and for those for whom a long hospital stay would not be a deterrent.
  3. For older adults with newly diagnosed AML considered candidates for intensive ALT, the ASH guideline panel suggests using either conventional induction and postremission therapy or HMA- or LDAC-based induction and postremission therapy in combination with venetoclax (conditional recommendation based on very low certainty in the evidence of effects ⨁◯◯◯).
  4. For older adults with AML who achieve remission after at least a single cycle of conventional induction therapy and who are not candidates for allogeneic hematopoietic stem cell transplantation (allo-HCT), the ASH guideline panel recommends postremission therapy over no additional therapy (strong recommendation based on low certainty in the evidence of effects ⨁⨁◯◯).
  5. Conventional therapy increases CR rates (odds ratio, 1.75; 95% CI, 1.25-2.38; high certainty in evidence).
  6. Postremission therapy probably decreases relapse at the longest follow-up (RR, 0.83; 95% CI, 0.70-0.98; mean, 51 months follow-up; moderate certainty in evidence).
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