Transplant Eligible and Ineligible Elderly Patients with AML—A Genomic Approach and Next Generation Questions

TL;DR

This paper reviews the challenges in treating elderly AML patients and highlights new genomic insights and risk stratification methods to improve outcomes.

Contribution

The paper introduces updated risk stratification from ELN-2022 and discusses genomic approaches for better treatment decisions in elderly AML patients.

Findings

Elderly AML patients have high relapse risks and poor survival despite new drug approvals.

The ELN-2022 risk stratification provides updated guidelines for managing elderly AML patients.

Multidisciplinary risk assessment is crucial for determining eligibility for allogeneic transplantation in elderly patients.

Abstract

The management of elderly patients diagnosed with acute myelogenous leukemia (AML) is complicated by high relapse risk and comorbidities that often preclude access to allogeneic hematopoietic cellular transplantation (allo-HCT). In recent years, fast-paced FDA drug approval has reshaped the therapeutic landscape, with modest, albeit promising improvement in survival. Still, AML outcomes in elderly patients remain unacceptably unfavorable highlighting the need for better understanding of disease biology and tailored strategies. In this review, we discuss recent modifications suggested by European Leukemia Network 2022 (ELN-2022) risk stratification and review recent aging cell biology advances with the discussion of four AML cases. While an older age, >60 years, does not constitute an absolute contraindication for allo-HCT, the careful patient selection based on a detailed and multidisciplinary risk stratification cannot be overemphasized.

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