Patterns of Care and Survival for Elderly Acute Myeloid Leukemia-Challenges and Opportunities

Acute myeloid leukemia (AML) is a disease of the elderly, with a median age of diagnosis in the sixth decade of life. Mortality has declined over the last few years, but this impact is apparent only in the young, fit AML population. Outcomes for the elderly remain poor, with less than 20% 5-year overall survival rates. Hence, there is an unmet need to identify treatment strategies to maximize benefit in this age group.

Elderly AML is a difficult entity to treat due to both disease and patient-related factors. Treatment of this group has a lot of inter-physician and inter-institutional variability. Several objective criteria to assess biological age, impact of co-morbidities, and fitness have been published, which could be utilized to make management decisions. For old and unfit AML patients, a variety of novel therapeutic agents are currently being investigated. Objective analysis of biological age should include assessment of fitness, frailty, and co-morbidities in elderly AML. Future areas of research include development of an objective risk-based approach and its validation in clinical trials, development of novel therapeutic agents, and improvement in supportive care measures.