[Therapeutic strategies for older adults with acute myeloid leukemia]

The treatment landscape for older adults with acute myeloid leukemia (AML) has undergone a paradigm shift, transitioning from a one-size-fits-all approach to personalized medicine driven by molecular profiling and novel therapeutics. Decision-making now necessitates a comprehensive assessment of leukemia-specific factors, such as genetic mutations and cytogenetics, alongside patient-specific factors evaluated through geriatric assessment. For fit patients, the integration of CPX-351 and FLT3 inhibitors into intensive chemotherapy has significantly improved transplant eligibility and survival outcomes. Conversely, for unfit patients, combinations of venetoclax and azacitidine or IDH1 inhibitors have been established as new standards of care with high response rates. Furthermore, advances in transplant technology have demonstrated improved survival outcomes following allogeneic hematopoietic cell transplantation, even in older adults. Recent data indicate that not only intensive chemotherapy but also less intensive therapies can serve as an effective bridge to transplant, achieving favorable long-term results. Modern management of AML in older adults must respect the highly diverse values of this age group. It is essential to propose a tailored treatment approach based on a thorough evaluation of leukemia biology, physical and cognitive function, and the treatment preferences of patients and their families. Such integrated strategies are key to optimizing clinical outcomes in this heterogeneous population.