Treatment of Newly Diagnosed AML with IDH1 Mutation in Older Adults (≥55 Years) Not Eligible for Conventional Induction
Clinical Scenario
This protocol applies to older adults aged 55 years or above with newly diagnosed acute myeloid leukemia carrying an IDH1 mutation. These patients are considered appropriate for antileukemic therapy but are not candidates for conventional induction and postremission therapy.
Treatment Approach
A combination regimen involving a hypomethylating agent together with a targeted agent is the preferred approach in this setting; at least one alternative combination is also available. Full regimen details, preferred sequencing, and decision criteria are contained in the complete protocol.
Clinical Goals
The primary objective is achieving complete remission (CR) or complete remission with incomplete hematologic recovery (CRi).
References
DOI: 10.1182/bloodadvances.2025017934
- For older adults with newly diagnosed AML and an IDH1 mutation considered appropriate for ALT but not for conventional induction and postremission therapy, the ASH guideline panel suggests azacitidine in combination with ivosidenib over azacitidine monotherapy (conditional recommendation based on low certainty in the evidence of effects ⨁⨁◯◯).
- For older adults with newly diagnosed AML and an IDH1 mutation considered appropriate for ALT but not for conventional induction and postremission therapy, the ASH guideline panel suggests using either azacitidine in combination with ivosidenib or an HMA in combination with venetoclax (conditional recommendation based on very low certainty in the evidence of effects ⨁◯◯◯).
- There is moderate-certainty evidence suggesting that azacitidine combined with ivosidenib, when compared with azacitidine alone, probably increases CR or CR with incomplete hematologic recovery (CRi) at the longest follow-up of the included study (RR, 3.34; 95% CI, 1.91-5.85; median, 15 months follow-up).
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