Acute myeloid leukemia (AML): Management in medically-unfit patients

Medically-unfit generally refers to patients with impaired PS (eg, ECOG PS 3) and moderate comorbidities (eg, CCI 3), rather than age, per se. This algorithm should be used together with related UpToDate topics for evaluation and diagnosis of AML, assessment of medical fitness, and management of AML.

AML: acute myeloid leukemia; CCI: Charlson cormorbidity index; ECOG: Eastern Cooperative Oncology Group; PS: performance status; HMA: hypomethylating agent; IDH1: isocitrate dehydrogenase 1; LoDAC: low-dose cytarabine.

* HMAs should be used with caution in patients with severe kidney or liver disease, as such patients were excluded from clinical trials; HMA dose should be reduced or delayed for unexplained declines in kidney or liver function.

¶ LoDAC-based combinations are preferred, rather than single-agent cytarabine. Examples include LoDAC plus venetoclax, LoDAC plus glasdegib, or LoDAC plus clofarabine.

Δ Selected patients may be candidates for targeted agents based on molecular findings and/or blast immunophenotype; examples include IDH1/2 inhibitors, gilteritinib, or gemtuzumab ozogamicin.

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Acute myeloid leukemia (AML): Management in medically-unfit patients