Older adults newly diagnosed with acute myeloid leukemia — particularly those aged 70 and above — frequently cannot safely undergo intensive induction and postremission therapy. For patients in this group who remain appropriate candidates for antileukemic therapy, an evidence-based approach distinct from conventional induction applies.
The preferred strategy for this population is built around a hypomethylating agent (HMA) in combination with an additional agent, continued until progression or unacceptable toxicity — with evidence showing significantly increased rates of complete remission compared with HMA alone. Alternative approaches exist for situations where the combination is not feasible.
DOI: 10.1182/bloodadvances.2025017934
For older adults with newly diagnosed AML considered appropriate for ALT but not for conventional induction and postremission therapy, the ASH guideline panel suggests HMA in combination with venetoclax over HMA alone (conditional recommendation based on moderate certainty in the evidence of effects ⨁⨁⨁◯).
HMA- or LDAC-based induction and postremission therapy in combination with venetoclax may be preferred for patients who are older (eg, aged ≥70 years) or with certain poor-risk cytogenetics or molecular mutations that may compromise response to conventional therapy.
Additionally, this combination probably increases CR at the longest follow-up (RR, 2.05; 95% CI, 1.40-2.99; moderate-certainty evidence).
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