Aims and options of palliative therapy for acute myeloid leukemia

Background Treatment of acute myeloid leukemia (AML) in patients who are not eligible for intensive chemotherapy due to age or comorbidities remains challenging. After introduction of epigenetic therapy with decitabine or azacytidine, combination treatment with azacytidine and the BCL-2 inhibitor venetoclax represents the current standard of care of first-line treatment in older AML patients. Diagnostics Molecular diagnostic approaches should consider analyses of FLT3, NPM1 as well as IDH1 and IDH2 mutations, which can be of both predictive and prognostic value. Perspective Palliative second-line treatment of older AML patients can either consider the FLT3 inhibitor gilteritinib in case of activating FLT3 mutations or should evaluate the inclusion into a clinical trial investigating either new target-therapy approaches or recently developed immunotherapeutic strategies.