American society of hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

Mikkael A. Sekeres*, Gordon Guyatt, Gregory Abel, Shabbir Alibhai, Jessica K. Altman, Rena Buckstein, Hannah Choe, Pinkal Desai, Harry Erba, Christopher S. Hourigan, Thomas W. LeBlanc, Mark Litzow, Janet MacEachern, Laura C. Michaelis, Sudipto Mukherjee, Kristen O'Dwyer, Ashley Rosko, Richard Stone, Arnav Agarwal, L. E. Colunga-LozanoYaping Chang, Qiu Kui Hao, Romina Brignardello-Petersen

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Background: Older adults with acute myeloid leukemia (AML) represent a vulnerable population in whom disease-based and clinical risk factors, patient goals, prognosis, and practitioner- and patientperceived treatment risks and benefits influence treatment recommendations. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about management of AML in older adults. Methods: ASH formed a multidisciplinary guideline panel that included specialists in myeloid leukemia, geriatric oncology, patient-reported outcomes and decision-making, frailty, epidemiology, and methodology, as well as patients. The McMaster Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline-development process, including performing systematic evidence reviews (up to 24 May 2019). The panel prioritized clinical questions and outcomes according to their importance to patients, as judged by the panel. The panel used the GRADE approach, including GRADE's Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 6 critical questions in managing older adults with AML, mirroring real-time practitioner-patient conversations: the decision to pursue antileukemic treatment vs best supportive management, the intensity of therapy, the role and duration of postremission therapy, combination vs monotherapy for induction and beyond, duration of less-intensive therapy, and the role of transfusion support for patients no longer receiving antileukemic therapy. Conclusions: Treatment is recommended over best supportive management. More-intensive therapy is recommended over less-intensive therapy when deemed tolerable. However, these recommendations are guided by the principle that throughout a patient's disease course, optimal care involves ongoing discussions between clinicians and patients, continuously addressing goals of care and the relative riskbenefit balance of treatment.

Original languageEnglish (US)
Pages (from-to)3528-3549
Number of pages22
JournalBlood Advances
Volume4
Issue number15
DOIs
StatePublished - Aug 11 2020

ASJC Scopus subject areas

  • Hematology

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