American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults.

Journal Article (Journal Article)

BACKGROUND: Older adults with acute myeloid leukemia (AML) represent a vulnerable population in whom disease-based and clinical risk factors, patient goals, prognosis, and practitioner- and patient-perceived treatment risks and benefits influence treatment recommendations. OBJECTIVE: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about management of AML in older adults. METHODS: ASH formed a multidisciplinary guideline panel that included specialists in myeloid leukemia, geriatric oncology, patient-reported outcomes and decision-making, frailty, epidemiology, and methodology, as well as patients. The McMaster Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline-development process, including performing systematic evidence reviews (up to 24 May 2019). The panel prioritized clinical questions and outcomes according to their importance to patients, as judged by the panel. The panel used the GRADE approach, including GRADE's Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. RESULTS: The panel agreed on 6 critical questions in managing older adults with AML, mirroring real-time practitioner-patient conversations: the decision to pursue antileukemic treatment vs best supportive management, the intensity of therapy, the role and duration of postremission therapy, combination vs monotherapy for induction and beyond, duration of less-intensive therapy, and the role of transfusion support for patients no longer receiving antileukemic therapy. CONCLUSIONS: Treatment is recommended over best supportive management. More-intensive therapy is recommended over less-intensive therapy when deemed tolerable. However, these recommendations are guided by the principle that throughout a patient's disease course, optimal care involves ongoing discussions between clinicians and patients, continuously addressing goals of care and the relative risk-benefit balance of treatment.

Full Text

Duke Authors

Cited Authors

  • Sekeres, MA; Guyatt, G; Abel, G; Alibhai, S; Altman, JK; Buckstein, R; Choe, H; Desai, P; Erba, H; Hourigan, CS; LeBlanc, TW; Litzow, M; MacEachern, J; Michaelis, LC; Mukherjee, S; O'Dwyer, K; Rosko, A; Stone, R; Agarwal, A; Colunga-Lozano, LE; Chang, Y; Hao, Q; Brignardello-Petersen, R

Published Date

  • August 11, 2020

Published In

  • Blood Adv

Volume / Issue

  • 4 / 15

Start / End Page

  • 3528 - 3549

PubMed ID

  • 32761235

Pubmed Central ID

  • PMC7422124

Electronic International Standard Serial Number (EISSN)

  • 2473-9537

Digital Object Identifier (DOI)

  • 10.1182/bloodadvances.2020001920


  • eng

Conference Location

  • United States