Shaw Briony, Ling Victoria Yee-May, Hubbard Ruth E, Bajel Ashish, Hiwase Devendra, Marlton Paula, Patil Sushrut, Perera Travis, Perram Jacinta, Tan Shuh Ying, Tan Xuan Ni, Wei Andrew, Hamad Nada, Chua Chong Chyn
Department of Clinical Haematology, Monash Medical Centre and Monash University, Melbourne, Victoria, Australia.
Department of Haematology, Princess Alexandra Hospital and The University of Queensland, Brisbane, Queensland, Australia.
Intern Med J. 2025 Jun;55(6):1013-1018. doi: 10.1111/imj.70086. Epub 2025 May 22.
The treatment of acute myeloid leukaemia (AML) is rapidly changing, and treatment decisions are more complex, with increasing therapeutic options available for those 'unfit' for intensive cytotoxic therapy. With the median age of 69 years at diagnosis, frailty is expected to be highly prevalent in patients with AML. An individualised approach is required, accounting for disease biology, chronological age, functional status, social factors, patient-directed goals of care and co-morbidities. This Australasian Leukaemia and Lymphoma Group (ALLG) consensus statement aims to highlight the importance of performing geriatric and frailty assessments (FAs) in older patients diagnosed with AML and provide practical recommendations on integrating FAs into routine clinical practice within the Australian and New Zealand context. We recommend FAs be widely implemented and tailored to the resources of individual centres to provide an objective measure of fitness of older patients with AML to assist therapeutic decisions at diagnosis as well as at serial timepoints throughout the disease course. Deficits in domains identified by FAs can specifically be targeted through supportive care interventions aiming to improve tolerance of therapy. FAs should be incorporated into clinical trials and be prioritised for funding and resources.
急性髓系白血病（AML）的治疗正在迅速变化，治疗决策更加复杂，对于那些“不适合”接受强化细胞毒性治疗的患者，可用的治疗选择越来越多。AML患者诊断时的中位年龄为69岁，预计虚弱在AML患者中非常普遍。需要一种个体化的方法，考虑疾病生物学、实际年龄、功能状态、社会因素、患者导向的护理目标和合并症。这份澳大利亚和新西兰白血病与淋巴瘤小组（ALLG）的共识声明旨在强调对诊断为AML的老年患者进行老年医学和虚弱评估（FAs）的重要性，并就澳大利亚和新西兰背景下将FAs纳入常规临床实践提供实用建议。我们建议广泛实施FAs，并根据各中心的资源进行调整，以提供老年AML患者身体状况的客观衡量标准，协助在诊断时以及疾病全过程的各个时间点做出治疗决策。通过旨在提高治疗耐受性的支持性护理干预措施，可以专门针对FAs所确定领域的缺陷。FAs应纳入临床试验，并在资金和资源方面给予优先考虑。
