Treatment of older and frail patients with AML

For elderly patients (>65 years), the best treatments are still a subject of discussion by haematologists because elderly patients with AML tend to:

  • Have high-risk AML
  • Not respond well to chemotherapy
  • Suffer more side effects with the currently established treatments.

For patients who cannot withstand intensive chemotherapy, low-intensity treatment with low-dose cytarabine or therapy and hydroxycarbamide (also called hydroxyurea) is often beneficial, and well tolerated.

Venetoclax (VenclyxtoÒ, AbbVie Deutschland GmbH & Co. KG) combined with a hypomethylating drug is effective in elderly patients. It is also valuable for patients who cannot tolerate intensive chemotherapy.

Venetoclax targets the BCL-2 protein in the leukaemia cells that prolongs the life of leukaemia cells.

Hypomethylating drugs prevent the addition of a methyl group to a component of the DNA molecule (DNA methylation). The effects of genes are conditional to DNA methylation.

Patients with heart disease cannot receive treatment with the following drugs because of their serious side cardiovascular side effects:

  • Anthracyclines
  • Chemotherapy drugs such mitoxantrone and arsenic trioxide

However, AML patients with heart problems can safely receive:

  • Fludarabine, cytarabine and granulocyte-colony stimulating factor
  • Cytarabine with topotecan or clofarabine