A physician’s view: facing the challenges of treating AML in older adults

When Dr. Daniel Pollyea, Director of Leukemia Services at University of Colorado Hospital, reflects on his experience treating patients with acute myeloid leukemia (AML), he alternates between optimism and frustration.

“We have an incredible opportunity to develop better treatment options – and even cures – for people with AML,” he says. “Still, right now every aspect of this disease represents an unmet need.”

During his residency, Dr. Pollyea was quickly drawn to a focus on AML, a disease caused by abnormalities in an early stage of myeloid cells in the bone marrow. It’s often known as the pervasive aggressor among other types of leukemia, as treating it (with therapies including chemotherapy, radiation and bone marrow transplant) is incredibly difficult in the group of people it most often strikes: adults older than 60.

When it comes to treating this older population, Dr. Pollyea and his colleagues face a number of limitations: “The disease biology is actually worse in older populations and, on top of that, it is more difficult for them to tolerate the standard of care therapies,” he explains.

What is it that makes a disease like AML so much more challenging if you are a senior?  Here, we take a further look at the odds facing older people with AML:

The median age at AML diagnosis is 67 years. At this age, the curability rate is between 5-15 percent, much lower than it is for younger adults or children, but the reason why is less clear.

“We know that older patients are less likely to respond to conventional treatments and less likely to achieve remission,” Pollyea explains. “And they are much less likely to have a favorable risk profile that’s associated with good long-term outcomes and cures. The reason why is largely unknown, but it’s clear that this disease is biologically different in older populations than a younger population. It’s just a different disease.”

But what makes AML look different as you age? The answer may lie in each person’s genes. Throughout our lives, our DNA changes and mutates, resulting in a uniquely characteristic pattern called a genetic signature.

When it comes to AML, researchers from the University of Toronto have narrowed the signatures down to a group of specific genes that are most critical for predicting outcomes. But for those who are older, this deeper understanding of our genetic profiles has led to another hurdle: scientists have learned that people over age 60 are more prone to have one of the genetic signatures that leads to less favorable outcomes.
 

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