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For appropriate secondary AML (sAML) patients, chemotherapy followed by HSCT is a treatment approach with curative intent1,2

4 Primary criteria for treatment decision

Primary criteria to consider when making a treatment decision for older AML and sAML patients3,4:

  • Clinical condition
  • Disease characteristics
  • Social support
  • Patient wishes

Treatment plans based solely on age may eliminate a potentially curative option for qualified patients1

  • The emotional toll on a patient following a diagnosis coupled with the pressure to make a quick treatment decision may impair their ability to make a truly informed choice5
  • It is important to discuss different options to determine the patient’s treatment goals. Informing them of differences in treatment duration and potential outcomes can help guide their decision‑making process

It is important to discuss all treatment options, including those with and without curative intent, with your patients

Treatment options for patients diagnosed with sAML

If you and your sAML patient have decided that a treatment goal of complete remission (CR) and, ultimately, cure is appropriate, consider them for HSCT1,2

Grandfather and granddaughter at table

Chemotherapy is an option for appropriate patients that may prolong survival and enable them to reach HSCT1

  • One study found that 20% to 50% of patients treated with chemotherapy achieved CR1,a
  • Patients receiving chemotherapy may require supportive care, which may include, but is not limited to: transfusion support, tumor lysis prophylaxis, anti-infectives, and/or growth factors6
  1. Analysis conducted at MD Anderson Cancer Center of 998 AML patients aged 65 and older receiving chemotherapy.1
Explore a treatment option >

HSCT after chemotherapy provides a treatment option with curative intent for appropriate sAML patients1,2

  • Factors that can inform a decision for HSCT include7:
    • Cytogenetic and molecular features
    • Comorbidities and performance status
    • Age
    • Donor availability
  • Improvements in HSCT have increased the safety and feasibility of this option in older patients2,8
    • Improved identification of appropriate patients
    • Increased donor availability
    • Improved treatment options, including reduced‑intensity conditioning
  • HSCT may provide longer‑term remission, especially in patients who achieve CR after induction therapy9
    • It is important to discuss with patients the possible side effects that may occur as a result of HSCT. These include prolonged leukopenia, resulting in infections, the most common complication following HSCT, and graft‑vs‑host disease (GvHD), which can be serious and life‑threatening10

Patients who are not eligible for intensive chemotherapy or HSCT may be treated with lower-intensity treatment options11

  • HMAs and low-dose chemotherapy options can be used as induction treatment for patients with newly diagnosed sAML who are not candidates for intensive chemotherapy, have poor performance status, or have significant comorbidities6,11
  • It is important to discuss possible side effects, such as thrombocytopenia, neutropenia, febrile neutropenia, and anemia, that may occur with these lower-intensity treatment options as well as with intensive chemotherapy and HSCT6

It is important to rethink sAML and consider whether treating appropriate patients from the start with an intent to cure will give them the best opportunity to achieve prolonged survival1,2

NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

AML=acute myeloid leukemia; HMA=hypomethylating agent; HSCT=hematopoietic stem cell transplant.

References: 1. Wang ES. Treating acute myeloid leukemia in older adults. Hematology Am Soc Hematol Educ Program. 2014;2014(1):14-20. 2. Lipof JJ, Loh KP, O’Dwyer K, et al. Allogeneic hematopoietic cell transplantation for older adults with acute myeloid leukemia. Cancers (Basel). 2018;10(6):179. 3. Almeida AM, Ramos F. Acute myeloid leukemia in the older adults. Leuk Res Rep. 2016;6:1-7. 4. Pettit K, Odenike O. Defining and treating older adults with acute myeloid leukemia who are ineligible for intensive therapies. Front Oncol. 2015;5:280. 5. LeBlanc TW, Fish LJ, Bloom CT, et al. Patient experiences of acute myeloid leukemia: a qualitative study about diagnosis, illness understanding, and treatment decision‐making. Psychooncology. 2017;26(12):2063-2068. 6. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Myeloid Leukemia V.3.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed May 7, 2019. To view the most recent and complete version of the guideline, go online to 7. Döhner H, Estey E, Grimwade D, et al. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood. 2017;129(4):424-447. 8. Arber DA, Borowitz MJ, Cessna M, et al. Initial diagnostic workup of acute leukemia: guideline from the College of American Pathologists and the American Society of Hematology. Arch Pathol Lab Med. 2017;141(10):1342-1393. 9. Medinger M, Lengerke C, Passweg J. Novel therapeutic options in acute myeloid leukemia. Leuk Res Rep. 2016;6:39-49. 10. Carreras E, Rambaldi A. Evaluation and counseling of candidates. In: Carreras E, Dufour C, Mohty M, et al, eds. The EBMT Handbook. Cham, Switzerland: Springer Nature; 2019:77-86. 11. Cheung E, Perissinotti AJ, Bixby DL, et al. The leukemia strikes back: a review of pathogenesis and treatment of secondary AML. Ann Hematol. 2019;98(3):541-559.