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How Genetics Can Drive Initial Therapy Choices for Older Patients with Acute Myeloid Leukemia

  • Leukemia (PH Wiernik, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Treatment of older adults with acute myeloid leukemia (AML) is challenging. Therapy decisions must be guided by multiple factors including aging-related conditions (e.g., comorbidities, functional impairment), therapy benefits and risks, patient preferences, and disease characteristics. Balancing these factors requires understanding the unique, and frequently higher-risk cytogenetic and molecular characteristics of AML in older adult populations, which should caution providers not to reduce therapy intensity on the basis of age alone. Instead, geriatric assessments should be employed to determine fitness for therapy. Treatment options in AML are increasingly targeted to specific mutations or recognized to have differential benefits on the basis of genomics, and representation of older adults and geriatric outcome reporting in clinical trials is improving. Additionally, newer studies have begun to explore personalized therapy strategies on the basis of initial genetic testing. Review and refinement of practice guidelines for older patients on the basis of these advances is needed and is anticipated to remain an important topic in ongoing hematology/oncology clinical education.

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Funding

Dr. Loh is supported by the National Cancer Institute at the National Institutes of Health (R00CA237744) and the Wilmot Research Fellowship Award.

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Authors and Affiliations

  1. Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA

    Jozal W. Moore MD, Nancy Torres MD, Jason H. Mendler MD, PhD & Kah Poh Loh MBBCh BAO, MS

  2. Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA

    Michael Superdock MD

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  1. Jozal W. Moore MD
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  2. Nancy Torres MD
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  3. Michael Superdock MD
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  4. Jason H. Mendler MD, PhD
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  5. Kah Poh Loh MBBCh BAO, MS
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Correspondence to Kah Poh Loh MBBCh BAO, MS.

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Kah Poh Loh has served as a consultant to Pfizer and Seattle Genetics and has received honoraria from Pfizer. Jozal W. Moore, Nancy Torres, Michael Superdock, and Jason H. Mendler have no relevant conflicts of interest to report.

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Moore, J.W., Torres, N., Superdock, M. et al. How Genetics Can Drive Initial Therapy Choices for Older Patients with Acute Myeloid Leukemia. Curr. Treat. Options in Oncol. 23, 1086–1103 (2022). https://doi.org/10.1007/s11864-022-00991-z

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