Appointment sheet
Acute myeloid leukaemia in older or unfit patients
Prepared with OnCo (onco.cc/prep/aml-older-unfit/). Orientation, not medical advice; your team knows your case.
My details
Name
Date of appointment
Hospital and clinician
Who is coming with me
What I know, what is unclear, changes to discuss
Saved in this browserWhat I know so far
What is unclear to me
Changes since last time
My questions
18 on the sheetNewly diagnosed
- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Performance status and geriatric assessment, Comorbidity index and organ function, ELN 2022 risk group, IDH1/2, NPM1, FLT3 and TP53 mutations, Measurable residual disease by flow cytometry), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
Newly diagnosed, unfit for intensive chemotherapy
- 5.For my situation (newly diagnosed, unfit for intensive chemotherapy), which of the standard options do you recommend and why?
- 6.Am I a candidate for Venetoclax, Azacitidine, Decitabine or related drugs, and what side effects should I expect?
- 7.How do the results of VIALE-A and AGILE apply to someone like me?
Fit older patients, 60 to 75
- 8.For my situation (fit older patients, 60 to 75), which of the standard options do you recommend and why?
- 9.Am I a candidate for Cytarabine + anthracycline ('7+3'), CPX-351 (liposomal daunorubicin-cytarabine), Midostaurin or related drugs, and what side effects should I expect?
Not a candidate for any leukaemia-directed therapy
- 10.For my situation (not a candidate for any leukaemia-directed therapy), which of the standard options do you recommend and why?
- 11.Am I a candidate for Hydroxyurea (hydroxycarbamide), Glasdegib, Cytarabine, and what side effects should I expect?
Relapse after venetoclax-azacitidine
- 12.For my situation (relapse after venetoclax-azacitidine), which of the standard options do you recommend and why?
- 13.Am I a candidate for Gilteritinib, Ivosidenib, Revumenib, and what side effects should I expect?
Any stage
- 14.Are there clinical trials I could join, for example of Venetoclax, Shorter venetoclax courses in unfit AML, myeloMATCH, G8 geriatric screening tool?
- 15.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 16.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 17.I read that “How long venetoclax needs to be given, and whether MRD-negative patients can stop”. How does that affect my plan?
- 18.I read that “Whether fit older patients do better with venetoclax-azacitidine than with intensive chemotherapy”. How does that affect my plan?
The words I may hear
- AML with myelodysplasia-related gene mutations (AML-MR): Eight genes (ASXL1, BCOR, EZH2, RUNX1, SF3B1, SRSF2, STAG2, U2AF1 and ZRSR2) are almost never mutated in leukaemia that arises out of nowhere but are typical of leukaemia that grew out of a smouldering marrow disorder; finding one on the diagnostic gene panel labels the AML as myelodysplasia-related, puts it in the adverse-risk group and changes the chemotherapy chosen.
- Hypomethylating agents (azacitidine, decitabine): Low-intensity chemotherapy that strips chemical 'off' switches (methyl groups) from DNA so silenced genes can be read again.
- ELN 2022 risk classification: The three-tier system (favourable, intermediate, adverse) that decides how aggressively an adult with AML is treated and whether a transplant is recommended.
- Tumour lysis syndrome (TLS): When a treatment kills cancer cells faster than the body can clear their contents, flooding the blood with potassium, phosphate and uric acid and injuring the kidneys and heart.
Tests and results to bring
Newly diagnosed, unfit for intensive chemotherapy: Venetoclax plus azacitidine (VIALE-A) or venetoclax plus decitabine; ivosidenib plus azacitidine for IDH1-mutated disease; targeted triplets in trials.
Biomarker results to ask for: Performance status and geriatric assessment, Comorbidity index and organ function, ELN 2022 risk group, IDH1/2, NPM1, FLT3 and TP53 mutations, Measurable residual disease by flow cytometry, Azole co-medication (venetoclax dose).
Scans and tests linked to this cancer: G8 geriatric screening tool.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Fit older patients, 60 to 75: 7+3 or CPX-351 for secondary disease, with a FLT3 inhibitor where indicated, and reduced-intensity allogeneic transplant in remission. (Cytarabine + anthracycline ('7+3'), CPX-351 (liposomal daunorubicin-cytarabine), Midostaurin, Quizartinib, Allogeneic stem cell transplantation)
- Not a candidate for any leukaemia-directed therapy: Hydroxyurea for count control, transfusion support and palliative care; low-dose cytarabine or glasdegib combinations where tolerated. (Hydroxyurea (hydroxycarbamide), Transfusion support and anaemia management, Glasdegib, Cytarabine)
- Relapse after venetoclax-azacitidine: Genotype-directed drugs (gilteritinib, IDH inhibitors, menin inhibitors) or trials; transplant for the few who respond. (Gilteritinib, Ivosidenib, Revumenib, Allogeneic stem cell transplantation)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.
Answers and next steps
Saved in this browserWhat I was told
Agreed next steps, dates and who to call