AML is a complex and challenging cancer with approximately 20,000 new cases diagnosed annually in the US. Despite decades of research, AML remains a difficult disease to treat due to its high rates of relapse and resistance. Traditionally, AML treatment followed a “one-size-fits-all” approach with intensive chemotherapy regimens, such as the ‘7 + 3’ combination of cytarabine and anthracycline. However, advances in molecular understanding of AML and the availability of new targeted therapies have shifted the treatment paradigm toward individualized care.¹

Tailoring Therapy Based on Patient and Disease Characteristics

One of the most significant developments in AML treatment is the ability to tailor therapies based on both patient fitness and the genetic profile of the disease. Patients who are younger and fit may still be candidates for intensive chemotherapy, while older or unfit patients now have highly effective low-intensity regimens available, such as hypomethylating agents (HMA) combined with venetoclax (Figure 1). For these patients, the combination of HMA and venetoclax has significantly improved complete remission rates and overall survival, offering a new standard of care.¹

In addition to fitness-based treatment choices, the genetic mutations driving AML also influence treatment decisions. Mutations in genes such as FLT3, IDH1, IDH2, and NPM1, among others, have led to the development of targeted therapies like midostaurin, gilteritinib, and enasidenib, offering precision medicine tailored to the molecular characteristics of the disease. With these advances, a more personalized approach to therapy has emerged, moving away from the traditional ‘7 + 3’ regimen for many patients.¹

Shared Decision-Making in AML Treatment

Given the complexity of AML treatment options and their potential impact on quality of life, shared decision-making (SDM) is essential for providing patient-centered care. SDM is a collaborative process in which clinicians and patients work together to make informed decisions based on medical evidence, patient preferences, and values.²

One model of SDM follows a 3-step framework: team talk, option talk, and decision talk (Figure 2). Initially, in team talk, the physician outlines the choices and engages the patient in a discussion about their role in decision-making. Next, during option talk, the clinician reviews the available treatment options in detail, emphasizing the potential risks and benefits. Finally, in decision talk, the patient is encouraged to make a decision based on their understanding and preferences. This approach fosters patient empowerment and ensures that decisions align with personal goals and values.³

Despite broad support for SDM among clinicians, barriers such as perceived time constraints and assumptions that certain patients may not be able to participate in SDM still exist. However, studies show that implementing SDM does not necessarily extend the length of clinical visits but alters the structure of consultations to accommodate a more patient-centered approach. To facilitate SDM effectively, evidence suggests that physician training programs are essential, regardless of a clinician’s experience level.³

The Impact of SDM on Patient Outcomes

SDM is particularly valuable in AML care, where multiple treatment options exist, and each has a different risk-benefit profile. By involving patients in the decision-making process, clinicians can ensure that treatment plans are tailored not only to the biological aspects of the disease, but also to the patient’s individual preferences and life circumstances. For instance, some patients may prioritize aggressive treatments to maximize the chances of remission, while others may opt for less intensive therapies to maintain a better quality of life during treatment.⁴

Studies show that patients who participate in SDM report greater satisfaction with their treatment choices and feel more confident about their care. Additionally, SDM can help clarify complex information and reduce decisional conflict, allowing patients to make choices that align with their values and long-term goals.⁴

The Future of AML Care: Precision Medicine and Beyond

As AML treatment continues to evolve, the integration of precision medicine is playing a critical role in personalizing care. The use of next-generation sequencing (NGS) and other molecular profiling technologies allows clinicians to develop more accurate diagnoses and predict treatment responses. Precision medicine enables personalized treatment plans that are specifically designed to target the genetic and molecular drivers of each patient’s disease.⁴

This individualized approach offers the potential to improve outcomes while minimizing unnecessary treatments and side effects. However, it also introduces complexity into decision-making, underscoring the importance of SDM in ensuring that treatment plans are not only scientifically appropriate but also in line with patient preferences and life circumstances.^2-4

References

1. Bazinet A, Kantarjian HM. Moving toward individualized target-based therapies in acute myeloid leukemia. Ann Oncol. 2023;34(2):141-151. doi:10.1016/j.annonc.2022.11.004
2. Shickh S, Leventakos K, Lewis MA, Bombard Y, Montori VM. Shared decision making in the care of patients with cancer. Am Soc Clin Oncol Educ Book. 2023;(43):e389516. doi:10.1200/EDBK_389516
3. Walker AR. How to approach shared decision making when determining consolidation, maintenance therapy, and transplantation in acute myeloid leukemia. Hematology. 2020;2020(1):51-56. doi:10.1182/hematology.2020000088
4. Grauman Å, Kontro M, Haller K, et al. Personalizing precision medicine: Patients with AML perceptions about treatment decisions. Patient Educ Couns. 2023;115:107883. doi:10.1016/j.pec.2023.107883