AML in older patients: are we making progress?

Older patients are generally, and arbitrarily, defined as those aged 60 and above. It is important to recognise that the effect of age is modulated by numerous other prognostic factors such as performance status, presence of various co-morbidities, and most importantly, cytogenetics. It is generally acknowledged that survival has not improved in a medically significant fashion for older patients. Nonetheless, there has been some progress. Specific improvements include the availability of new therapies, including reduced intensity allogeneic haematopoietic stem cell transplant; the subdivision of the resistant response category into subcategories, such as complete response with incomplete platelet recovery (CRp); the introduction of selection designs prior to initiating large phase 3 trials; the departure from the view that all older patients are the same and are, for example, necessarily candidates for trials of new drugs; increased awareness of the effect of selection bias; and increased questioning of certain practices, such as the imposition of a neutropenic diet, and recommendations to wear masks or avoid crowds.