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General Updates | Deciding between intensive induction versus lower-intensity approaches in older patients with AML
Jeffrey Lancet, MD, Moffitt Cancer Center, Tampa, FL, outlines the key factors that influence the decision between intensive induction and lower-intensity therapeutic approaches (e.g., a hypomethylating agent (HMA) plus venetoclax) for older patients with newly diagnosed acute myeloid leukemia (AML). These include patient fitness, comorbidities, age, and disease biology, as per the recently published American Society of Hematology (ASH) 2025 guidelines. This interview took place virtually.
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Transcript
Yeah, there are a variety of factors that kind of play into the decision of intensive versus non-intensive therapy. One of the key factors is the degree of fitness and number of comorbidities affecting patients, so that patients who are considered more frail on the basis of performance status or other coexistent medical problems like underlying heart disease, lung disease, kidney disease, patients with those types of problems are more suitable for an HMA-venetoclax lower intensity approach than more intensive induction chemotherapy...
Yeah, there are a variety of factors that kind of play into the decision of intensive versus non-intensive therapy. One of the key factors is the degree of fitness and number of comorbidities affecting patients, so that patients who are considered more frail on the basis of performance status or other coexistent medical problems like underlying heart disease, lung disease, kidney disease, patients with those types of problems are more suitable for an HMA-venetoclax lower intensity approach than more intensive induction chemotherapy. You can also consider age over 75 as being a factor favoring lower-intensity therapy. When it comes to the disease biology, we often use the ELN risk stratification as a guide for intensive versus low intensity therapy in older patients. So for example, if a patient has a favorable risk leukemia, such as a core binding factor leukemia, or perhaps an NPM1-mutated leukemia, those patients would be more strongly considered for more intensive induction chemotherapy than, for example, a patient with higher risk biologic features such as loss of chromosome 7 or loss of chromosome 5 or adverse genetic mutations such as are outlined in the ELN 2022 risk scoring system that include MDS-related mutations and things like that. So I think the biology of the disease being favorable would have an influence on the decision for intensive induction therapy versus lower intensity therapy. And those are, I think, the two major considerations when it comes to deciding intensive versus non-intensive approaches.
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