Abstract
Acute myeloid leukemia (AML) is associated with poor outcomes in older adults. A major
goal of treatment is to balance quality of life and functional independence with disease
control. With the approval of new, more tolerable regimens, more older adults are
able to receive AML-directed therapy. Among these options are hypomethylating agents
(HMAs), specifically azacitidine and decitabine. HMAs have become an integral part
of AML therapy over the last two decades. These agents are used either as monotherapy
or nowadays more commonly in combination with other agents such as the Bcl-2 inhibitor
venetoclax. Biological AML characteristics, such as molecular and cytogenetic risk
factors, play crucial roles in guiding treatment decisions. In patients with high-risk
AML, HMAs are increasingly used rather than intensive chemotherapy, although further
trials based on a risk-adapted approach using patient- and disease-related factors
are needed. Here, we review trials and evidence for the use of HMA monotherapy and
combination therapy in the management of older adults with AML. Furthermore, we discuss
the use of HMAs and HMA combination therapies in AML, mechanisms of action, their
incorporation into hematopoietic stem cell transplantation strategies, and their use
in patients with comorbidities and reduced organ function.
Keywords
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Article info
Publication history
Published online: November 23, 2022
Accepted:
November 17,
2022
Received in revised form:
October 23,
2022
Received:
May 6,
2022
Publication stage
In Press Corrected ProofIdentification
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© 2022 Elsevier Ltd. All rights reserved.
