Management of Acute Myeloid Leukemia in Older Patients: An Updated Canadian Consensus

These are the third Canadian consensus guidelines on the management of acute myeloid leukemia (AML) in older patients. The first was published in 2013, and the second in 2017. The management of AML in older patients changed significantly over this time span, with decreasing emphasis on the use of intensive chemotherapy and the adoption of new standards of care based on less-intensive therapies: first azacitidine + venetoclax combinations, followed by azacitidine + ivosidenib. Increased use of these new therapies in older patients has raised questions about their use, including how to determine patient suitability, select the most effective therapy, and manage dosing and toxicity. In this third Canadian guideline, we address these questions to provide clarity around these new standards of care and improve clinician understanding and confidence in using them. As more new targeted agents become available and hypomethylating agent-based triplet combinations are used more widely, we fully anticipate that we will, in some years’ time, write a fourth guideline on the management of AML in older patients.