Am J Blood Res 2013;3(2):141-164
Original Article
Treatment of older patients with acute myeloid leukemia (AML): a Canadian
consensus
Joseph M Brandwein, Michelle Geddes, Jeannine Kassis, Andrea K Kew, Brian Leber, Thomas Nevill, Mitchell Sabloff,
Irwindeep Sandhu, Andre C Schuh, John M Storring, John Ashkenas
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario; Division of Hematology
and Hematologic Malignancy, Department of Medicine, University of Calgary, Calgary, Alberta; Department of Hematolgy,
Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Québec; Division of Hematology, Queen Elizabeth II Health
Sciences Centre, Halifax, Nova Scotia; Juravinski Cancer Centre, Hamilton Health Sciences: McMaster University, Hamilton,
Ontario; Vancouver General Hospital, Vancouver, British Columbia; Department of Medicine, Division of Hematology, The
Ottawa Hospital, University of Ottawa, Ottawa, Ontario; Division of Clinical Hematology, Department of Medicine, Faculty of
Medicine & Dentistry, University of Alberta; Division of Hematology, McGill University Health Centre, Montreal, Quebec; SCRIPT,
Toronto, Ontario, Canada
Received January 10, 2013; Accepted March 23, 2013; Epub May 5, 2013; Published May 15, 2013
Abstract: Patients over age 60 comprise the majority of those diagnosed with acute myeloid leukemia (AML), but treatment
approaches in this population are variable, with many uncertainties and controversies. Our group conducted a literature review
to summarize the latest information and to develop a consensus document with practical treatment recommendations. We
addressed five key questions: selection criteria for patients to receive intensive induction chemotherapy; optimal induction and
post-remission regimens; allogeneic hematopoietic stem cell transplantation (HSCT); treatment of patients not suitable for
induction chemotherapy; and treatment of patients with prior hematological disorders or therapy-related AML. Relevant
literature was identified through a PubMed search of publications from 1991 to 2012. Key findings included the recognition
that cytogenetics and molecular markers are major biologic determinants of treatment outcomes in the older population, both
during induction therapy and following HSCT. Although disease-specific and patient-specific risk factors for poor outcomes
are more common in the older population, age is not in itself sufficient grounds for withholding established treatments,
including induction and consolidation chemotherapy. The role of HSCT and use of hypomethylating agents are discussed.
Finally, suggested treatment algorithms are outlined, based on these recommendations. (AJBR1301001).
Keywords: Acute myeloid leukemia, chemotherapy, cytogenetics, prognosis, hematopoietic stem cell transplantation,
hypomethylating agent
Address correspondence to: Dr. Joseph M Brandwein, Department of Medical Oncology and Hematology, Princess Margaret
Cancer Centre, Toronto, Ontario, Canada. Tel: 416-946-6546; Fax: 416-946-6546; E-mail: joseph.brandwein@uhn.ca
Original Article
Treatment of older patients with acute myeloid leukemia (AML): a Canadian
consensus
Joseph M Brandwein, Michelle Geddes, Jeannine Kassis, Andrea K Kew, Brian Leber, Thomas Nevill, Mitchell Sabloff,
Irwindeep Sandhu, Andre C Schuh, John M Storring, John Ashkenas
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario; Division of Hematology
and Hematologic Malignancy, Department of Medicine, University of Calgary, Calgary, Alberta; Department of Hematolgy,
Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Québec; Division of Hematology, Queen Elizabeth II Health
Sciences Centre, Halifax, Nova Scotia; Juravinski Cancer Centre, Hamilton Health Sciences: McMaster University, Hamilton,
Ontario; Vancouver General Hospital, Vancouver, British Columbia; Department of Medicine, Division of Hematology, The
Ottawa Hospital, University of Ottawa, Ottawa, Ontario; Division of Clinical Hematology, Department of Medicine, Faculty of
Medicine & Dentistry, University of Alberta; Division of Hematology, McGill University Health Centre, Montreal, Quebec; SCRIPT,
Toronto, Ontario, Canada
Received January 10, 2013; Accepted March 23, 2013; Epub May 5, 2013; Published May 15, 2013
Abstract: Patients over age 60 comprise the majority of those diagnosed with acute myeloid leukemia (AML), but treatment
approaches in this population are variable, with many uncertainties and controversies. Our group conducted a literature review
to summarize the latest information and to develop a consensus document with practical treatment recommendations. We
addressed five key questions: selection criteria for patients to receive intensive induction chemotherapy; optimal induction and
post-remission regimens; allogeneic hematopoietic stem cell transplantation (HSCT); treatment of patients not suitable for
induction chemotherapy; and treatment of patients with prior hematological disorders or therapy-related AML. Relevant
literature was identified through a PubMed search of publications from 1991 to 2012. Key findings included the recognition
that cytogenetics and molecular markers are major biologic determinants of treatment outcomes in the older population, both
during induction therapy and following HSCT. Although disease-specific and patient-specific risk factors for poor outcomes
are more common in the older population, age is not in itself sufficient grounds for withholding established treatments,
including induction and consolidation chemotherapy. The role of HSCT and use of hypomethylating agents are discussed.
Finally, suggested treatment algorithms are outlined, based on these recommendations. (AJBR1301001).
Keywords: Acute myeloid leukemia, chemotherapy, cytogenetics, prognosis, hematopoietic stem cell transplantation,
hypomethylating agent
Address correspondence to: Dr. Joseph M Brandwein, Department of Medical Oncology and Hematology, Princess Margaret
Cancer Centre, Toronto, Ontario, Canada. Tel: 416-946-6546; Fax: 416-946-6546; E-mail: joseph.brandwein@uhn.ca
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