Developing Multidisciplinary Algorithm for AML Induction in Elderly Benefits Nurses

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For older individuals, an AML diagnosis can present treatment option challenges.
For older individuals, an AML diagnosis can present treatment option challenges.
The following article features coverage from the 2018 Oncology Nursing Society's Annual Conference in Washington, DC. Click here to read more of Oncology Nurse Advisor's conference coverage. 

WASHINGTON, DC — A multidisciplinary approach to developing an algorithm for managing acute myeloid leukemia (AML) in patients 60 years and older can improve nurse and clinician knowledge of induction treatment in this patient population as well as improve patient care, according to a presentation at the 2018 Oncology Nursing Society (ONS) Annual Congress.

A diagnosis of acute myeloid leukemia presents challenges when considering treatment options for patients older than 60 years. Adverse predictors of prognosis in this patient population include comorbidities, performance status, individual cytogenetics, and secondary vs de novo disease. A multidisciplinary approach to treatment selection that incorporates patient- and disease-related characteristics is recommended to ensure optimal outcomes.

To develop an algorithm for AML induction therapy in adult patients older than 60, a multidisciplinary team conducted a retrospective chart review of elderly patients with AML treated at Lehigh Valley Health Network (LVHN) from 2010 to 2014. The review revealed an overall survival rate of 13% in 120 cases of AML. Patients were aged 61 to 92 years, comorbidities were noted in 97% of patients, and at 5 years, none of the patients in the poor risk cytogenetic group had survived.

The multidisciplinary team working on the algorithm represented hematology-oncology (nurses, physicians, and PAs), palliative care, pharmacy, rehabilitation services, clinical trials, and a hematopathologist.

The algorithm components included pretreatment evaluations of patient- and disease-related characteristics; an AML-Score calculator to predict mortality risk and potential for complete remission during induction; and referrals to rehabilitation services, to assess for fitness vs frailty, and to palliative care, to assess for goals of care and promote patient-focused decision making. Treatment regimens were based on recommendations from the National Comprehensive Cancer Network (NCCN) Guidelines for Acute Myeloid Leukemia Age ≥60. 

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