Treatment of Acute Myeloid Leukemia in Older Adults

SIMPLE SUMMARY: In this review article, we describe the landscape of available treatments for older and medically unfit patients with AML. We review the historical practice of AML treatment in older adults before discussing the current standard of care therapies and future therapeutic options. We highlight some of the challenges facing the care of older adults with AML including underrepresentation in clinical trials and shed light on the importance of evaluating clinical outcomes that are relevant to our patients and their values. ABSTRACT: Acute Myeloid Leukemia (AML) is an aggressive myeloid malignancy predominantly affecting older adults. Despite the advancements in new therapies for AML, older and medically unfit patients continue to suffer from poor outcomes due to disease-related factors such as the mutational profile and patient-related factors such as comorbidities and performance status. In this review, we discuss a spectrum of therapeutic options for older patients with AML starting with a historical perspective and ending with therapies being investigated in clinical trials. We review the standard of care treatment options including combination venetoclax and hypomethylating agents, in addition to targeted therapies such as FLT3 and IDH inhibitors. Lastly, we shed light on challenges facing the care of older adults and their representation in clinical trials.