How I treat acute myeloid leukemia presenting with preexisting comorbidities Review uri icon

Overview

MeSH Major

  • Cardiomyopathies
  • Cerebrovascular Disorders
  • Leukemia, Myeloid, Acute
  • Liver Cirrhosis
  • Myocardial Ischemia
  • Renal Insufficiency, Chronic

abstract

  • Acute myeloid leukemia (AML) is a devastating disease with an incidence that progressively increases with advancing age. Currently, only ∼40% of younger and 10% of older adults are long-term survivors. If untreated, the overall prognosis of AML remains dismal. Initiation of therapy at diagnosis is usually urgent. Barriers to successful therapy for AML are the attendant toxicities directly related to chemotherapy or those associated with inevitable aplasia. Organ dysfunction often further complicates such toxicities and may even be prohibitive. There are few guidelines to manage such patients and the fear of crossing the medico-legal abyss may dominate. Such clinical scenarios provide particular challenges and require experience for optimal management. Herein, we discuss select examples of common pretreatment comorbidities, including cardiomyopathy, ischemic heart disease; chronic renal failure, with and without dialysis; hepatitis and cirrhosis; chronic pulmonary insufficiency; and cerebral vascular disease. These comorbidities usually render patients ineligible for clinical trials and enormous uncertainty regarding management reigns, often to the point of withholding definitive therapy. The scenarios described herein emphasize that with appropriate subspecialty support, many AML patients with comorbidities can undergo therapy with curative intent and achieve successful long-term outcome.

publication date

  • July 28, 2016

Research

keywords

  • Review

Identity

Language

  • eng

PubMed Central ID

  • PMC5524532

Digital Object Identifier (DOI)

  • 10.1182/blood-2016-01-635060

PubMed ID

  • 27235136

Additional Document Info

start page

  • 488

end page

  • 96

volume

  • 128

number

  • 4