Newly Diagnosed AML: Treatment Goals and Current Standard-of-Care Regimens

In "Newly Diagnosed AML: Treatment Goals and Current Standard-of-Care Regimens," the panel opens its second section by mapping today's frontline options.

Dr. Mahmoudjafari introduces the second section, which evaluates current treatment options, mechanisms of action, trial data, and therapeutic challenges in older and unfit patients. Dr. Murthy describes four goals of treatment for unfit patients. The first two are efficacy objectives: achieving remission and improving survival. The other two matter most to patients: limiting side effects and preserving quality of life. He wants unfit patients to have the same chance at remission as those receiving intensive therapy.

Dr. Zeidan then reviews the standard of care for newly diagnosed AML. He frames the goals as achieving complete remission and then keeping patients there. Current therapies are good at inducing remission, but relapse remains common and is very difficult to cure. For fit patients, the most common induction regimen is 7+3, pairing seven days of cytarabine with three days of an anthracycline. Over the past decade, two FLT3 inhibitors have been approved alongside chemotherapy in the frontline setting. Many clinicians add gemtuzumab ozogamicin for core binding factor leukemia. Trials combining IDH inhibitors with intensive chemotherapy, including work led by Dr. Stein, are ongoing but not yet standard.

Dr. Zeidan notes the growing debate about whether every patient who can receive intensive chemotherapy should. For patients aged 60 to 75, he generally avoids intensive chemotherapy if transplant is planned anyway. He favors it when cure without transplant seems possible, such as in NPM1-mutated disease. Patients who cannot tolerate intensive chemotherapy most commonly receive azacitidine plus venetoclax. An IDH1 inhibitor is also approved with azacitidine, and an all-oral doublet was approved a few months ago. Single-agent IDH inhibitors remain options for very old, frail patients. Consolidation decisions depend on clinical data, donor availability, social support, and patient preference. Patients on azacitidine plus venetoclax typically continue therapy for as long as they derive benefit.

In "Stem Cell Transplant Timing and Intensive Chemotherapy Trade-offs in AML," Dr. Stein will walk through transplant timing and Dr. Murthy will weigh the trade-offs of intensive chemotherapy.