Acute promyelocytic leukemia (APL) represents a remarkable disease in which leukemogenesis is driven by the PML-RARα oncogene and for which targeted treatment with all-trans retinoic acid (ATRA)–based therapy allows substantial chance of cure. APL is seen in a small subset of older patients, with age representing one of the most important prognostic factors for outcome of treatment. Unlike other acute leukemias, the inferior outcomes for APL in older patients relates less to changes in disease biology and more to the increased toxicity of ATRA and the chemotherapy combination regimens used to induce hematologic and molecular responses. Risk-adapted strategies that use less-toxic agents, such as arsenic trioxide, allow treatment of older patients, with greater efficiency and better chances of cure.
Thomas Prebet and Steven D. Gore
Martin S. Tallman, Eunice S. Wang, Jessica K. Altman, Frederick R. Appelbaum, Vijaya Raj Bhatt, Dale Bixby, Steven E. Coutre, Marcos De Lima, Amir T. Fathi, Melanie Fiorella, James M. Foran, Aric C. Hall, Meagan Jacoby, Jeffrey Lancet, Thomas W. LeBlanc, Gabriel Mannis, Guido Marcucci, Michael G. Martin, Alice Mims, Margaret R. O’Donnell, Rebecca Olin, Deniz Peker, Alexander Perl, Daniel A. Pollyea, Keith Pratz, Thomas Prebet, Farhad Ravandi, Paul J. Shami, Richard M. Stone, Stephen A. Strickland, Matthew Wieduwilt, Kristina M. Gregory, OCN, Lydia Hammond and Ndiya Ogba
Acute myeloid leukemia (AML) is the most common form of acute leukemia among adults and accounts for the largest number of annual deaths due to leukemias in the United States. Recent advances have resulted in an expansion of treatment options for AML, especially concerning targeted therapies and low-intensity regimens. This portion of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for AML focuses on the management of AML and provides recommendations on the workup, diagnostic evaluation and treatment options for younger (age <60 years) and older (age ≥60 years) adult patients.