TY - JOUR
T1 - American society of hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults
AU - Sekeres, Mikkael A.
AU - Guyatt, Gordon
AU - Abel, Gregory
AU - Alibhai, Shabbir
AU - Altman, Jessica K.
AU - Buckstein, Rena
AU - Choe, Hannah
AU - Desai, Pinkal
AU - Erba, Harry
AU - Hourigan, Christopher S.
AU - LeBlanc, Thomas W.
AU - Litzow, Mark
AU - MacEachern, Janet
AU - Michaelis, Laura C.
AU - Mukherjee, Sudipto
AU - O'Dwyer, Kristen
AU - Rosko, Ashley
AU - Stone, Richard
AU - Agarwal, Arnav
AU - Colunga-Lozano, L. E.
AU - Chang, Yaping
AU - Hao, Qiu Kui
AU - Brignardello-Petersen, Romina
N1 - Publisher Copyright:
© 2020 American Society of Hematology. All rights reserved.
PY - 2020/8/11
Y1 - 2020/8/11
N2 - 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.
AB - 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.
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U2 - 10.1182/bloodadvances.2020001920
DO - 10.1182/bloodadvances.2020001920
M3 - Review article
C2 - 32761235
AN - SCOPUS:85090204128
SN - 2473-9529
VL - 4
SP - 3528
EP - 3549
JO - Blood Advances
JF - Blood Advances
IS - 15
ER -