iwAL 2019 | The challenges of treating AML in older patients

The biggest challenge in AML, until recently, has been the treatment of older adults with AML, and that’s the population over the age of about 60, and that’s actually the vast majority of adults with AML.

The problem has been that only a subset of these patients could tolerate the cytotoxic regiments based on cytarabine and anthracycline, and even those who tolerated it didn’t have long term leukemia-free survival.

So the progress has been limited in what we call older or elderly AML, but the introduction of venetoclax-based regiments has changed this, because now we have effective strategies that are also relatively non-toxic and this, in my opinion, will dramatically change the picture in older AML therapy.

In the younger patients, we’ve also been fairly stuck at a ceiling of long term survival, and the advances in that population have been the identification of subsets with genetic abnormalities that are susceptible to specific therapies.

The approval of FLT3 inhibitors, midostaurin, and gilteritinib, potentially in the near future. Quizartinib will help FLT3-mutated patients, at least to some extent, and the approval of IDH1 and IDH2 inhibitors, enasidenib and ivositenib is also benefiting the IDH mutated population, at least to some extent.