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Acute Myeloid Leukemia

Deciding the Optimum Treatment Options for Acute Myeloid Leukemia

Acute Myeloid Leukemia—So Many Treatment Options; How Do You Decide?
Speaker details: Dr. Jacqueline S. Garcia, Dr. Alison R. Walker

Until recently, treatment options for patients with newly diagnosed and relapsed/refractory acute myeloid leukemia (AML) were limited to cytotoxic chemotherapeutic agents that possessed little specificity for the cytogenetic and molecular mutations. Moreover, treatment often started very soon after the diagnosis was made with limited consideration for disease-specific characteristics. Apart from emergent presentations, the majority of patients with a new diagnosis of AML now undergo a complete molecular and cytogenetic evaluation that in many cases decides the treatment plan. As a result, not only have the agents that were used to treat patients changed, the way that clinicians talk about these options with patients, decide on, and manage therapy have also been transformed (ASH 2020)

Does Patient Fitness Play a Role in Determining First-Line Treatment for Acute Myeloid Leukemia? 27

  • Treatment of AML should not follow the ‘one-size fitsall’ strategy.
  • Clinical fitness, mutations, and patient preference should guide treatment selection.
  • Impaired cognitive, physical function, and gait should shed light on patient fitness
  • Recently approved frontline therapies, such as azacitidine and venetoclax, are the new standard of care for unfit patients, while azacitidine and ivosidenib have a deeper durable response.
  • Intensive and non-intensive combination strategies and functional biomarkers can help in tailoring treatment for individual patients.

How to Approach Shared Decision-Making in Determining Maintenance, Consolidation Therapy, and Transplant? 28

  • Shared decision-making (SDM) is based on the belief that a patient’s needs and desired outcomes should be the basis of all clinical decisions.
  • The majority of clinicians agree that for a particular scenario, there may be more than one correct option when it comes to choosing therapies.
  • Information about the existing options can be shared with the patient, and they can be encouraged to consider their own preferences.
  • Clinicians can follow the three-talk model in SDM for the best outcomes (Figure 1).