Management of Elderly AML

Acute myeloid leukemia (AML) has established treatment plans in young and fit patients. They are usually treated with intensive chemotherapy (IC) followed by post-remission consolidation with either intermediate-high dose cytarabine or hematopoietic stem cell transplantation (HSCT) based on genetic risk stratification. However, being a disease that predominantly affects the elderly, there is a lack of standard therapy in this subset. They are rarely candidates to take IC owing to comorbidity and frailty. Besides, adverse cytogenetic mutations seem to occur in elder AML patients more than in younger ones, making complications that follow IC not worth it, given the risks of resistant disease (RD) and relapses. Therapy with a hypomethylating agent (HMA) and targeted therapy forms the most suitable plan for elders. The latest World Health Organization (WHO) 2022 AML classification has adequately emphasized genetic and molecular profiling, which has paved the way for the identification of many more potential targets and therapies. This article provides an overview of the evolution of treatment in elderly AML from the past, currently available options, and various targeted therapies already available and in the pipeline.