iwAL 2025 | Navigating the complex AML landscape: advice for community oncologists

I think that community doctors in the United States are extraordinary. I have lots of friends in community practice and I don’t understand what they do because I can hardly know the very small area that I am expert in and they have to do it all. And I think that increasingly the availability of oral, very well-tolerated therapies, especially for a disease where the median age is around 70 means that people in a very big country like the U.S. are going to want to be at home. They’re going to want to be on oral therapies, and they’re going to not want to come into academic centers. So this is a problem because for a rare disease like AML with poor outcomes, we want everybody to be monitored closely on clinical trials, preferably so that we can move forward the art and the science. But at the same time, there is a practical reality that people need to be with their families and at home. And now that there are oral, well-tolerated approaches, that’s going to happen increasingly. So the best advice is to phone a friend. And I would say there are actually, I have lots of colleagues and friends who email routinely. I think the networking in the current age is not only possible but mandatory. And I think there is a lot going on that is actually quite confusing. And I think that it is a phone-a-friend moment, especially for things like dosing and schedule questions when there are multiple agents involved for older and more frail patients. And the other piece of advice that I think is a very, very strong one is don’t be seduced by the oral well-tolerated therapy. This is still AML, and I have a very low threshold to admit patients for the entire cycle of induction, even if it’s 20 or 30 days in the hospital, which in many parts of the world would be a true problem. And even in the United States, it can be a problem. But those patients need to be very, very closely monitored. It’s a very dangerous disease. And once they’re in remission, they have truly meaningful long survival with excellent quality of life, so it’s worth it. In the past, even 20 years ago, it might not have been worth it because the remissions were so short for older patients. But now they’re long and worth it. And don’t get tangled up with too many bad things in induction with the patient in the hospital.

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