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Key Patient Factors to Consider in AML Treatment Decisions
Panelists discuss how fitness assessment has evolved beyond traditional age cutoffs to incorporate comprehensive geriatric assessments, frailty measures, and individualized evaluations, while questioning whether intensive therapy should automatically be given to fit patients given newer effective treatment options.
Health care providers now recognize that determining treatment intensity requires careful evaluation of multiple patient factors beyond chronological age, including physiologic function, social support systems, and individual health goals. Patients increasingly benefit from comprehensive geriatric assessments that evaluate frailty, cognitive function, nutritional status, and psychosocial factors that influence treatment tolerance. The traditional distinction between “fit” and “unfit” patients has evolved as new, effective treatment options become available for those previously considered unable to tolerate intensive therapy.
Modern acute myeloid leukemia (AML) care emphasizes shared decision-making between patients, families, and health care teams to determine whether the treatment goal is cure or life extension with quality time. For patients where cure remains possible, considerations include the potential need for bone marrow transplantation as part of the overall treatment strategy. The availability of highly effective lower-intensity regimens means that some patients previously deemed “unfit” for intensive chemotherapy can now receive meaningful treatment that extends survival while preserving quality of life.
Social determinants of health significantly impact patient outcomes, particularly regarding access to specialized care, transportation to treatment centers, and ability to manage frequent medical appointments. Patients living far from treatment centers face unique challenges, especially during the intensive monitoring periods required for AML therapy. Health care teams increasingly recognize the importance of addressing these practical barriers through telemedicine support, local care coordination, and consideration of oral treatment options that reduce the burden of frequent clinic visits while maintaining treatment effectiveness.
