General Updates | Deciding whether an older patient with AML is a suitable candidate for antileukemic therapy

Yeah, it’s an important question, and I think it’s one that probably needs to be asked for every patient that comes through the door with AML that is older. The evidence is quite clear that both long-term and short-term outcomes are superior with therapy than without therapy in older patients, and that many of the potential complications of chemotherapy are quite similar to the complications of the natural history of the AML, such that these are patients that require a lot of transfusions and hospitalizations and care for infections, so that in some, the benefits outweigh the risks of anti-leukemic therapy. I guess to answer the question about how we should decide who is suitable and who is not suitable, it really comes down to a patient’s goals of care and if they desire to have some level of improved outcomes with regard to survival and improved blood counts to help determine whether they should or should not receive chemotherapy. But it’s a minority of patients, in my estimation, and I think in the panel’s estimation, that should not be considered for chemotherapy because of the fact that the outcomes are superior. But it does come down to really a discussion about the patient’s goals of care, the level of support that they have at home to help provide care for them when they’re going through treatment, logistical considerations that ultimately will help clinicians decide who may not be a suitable candidate for chemotherapy. But overall, the consensus was quite strong that the large majority of older patients should be recommended and offered anti-leukemic therapy.

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