AML Guideline Reinforces Individualized Treatment
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Appropriately selected and counseled older patients with acute myeloid leukemia (AML) should receive chemotherapy in preference to supportive care and more-intensive versus less-intensive therapy if they can tolerate it, according to new recommendations from the American Society of Hematology (ASH).

Additionally, patients in end-of-life or hospice care, should be offered palliative red-cell transfusions, which have proven beneficial in the absence of antileukemic treatment.

The panel sought to address the reluctance, toxicity concerns, and other issues head on with evidence-based recommendations derived in large part from results of randomized clinical trials, he continued. The guidelines offer recommendations for patients across the entire spectrum of AML from newly diagnosed disease to postremission to hospice care.

The guideline includes support for:

-- Intensive antileukemic therapy over less-intensive therapy for patients with newly diagnosed AML
-- Postremission therapy versus no additional therapy for patients who achieve remission following at least one cycle of intensive therapy and are ineligible for stem-cell transplantation
-- Use of a hypomethylating agent or low-dose cytarabine in patients ineligible for intensive therapy
-- Continued treatment for patients who respond to less-intensive therapy without intolerable side effects.
-- Red-cell transfusions for patients no longer receiving antileukemic therapy, including patients in hospice care.

"We recognize the serious issues that patients face, including the side effects and risks of chemotherapy and time in the hospital," said authors. "Weighing these issues against possible benefits, including remission and extended life, patients can decide what treatment is consistent with their goals."