Key points
- Age alone is not a reason not to treat. For older people who cannot tolerate intensive chemotherapy, there are gentler, effective treatments [1].
- Venetoclax with azacitidine more than doubled the chance of remission, and two years later twice as many patients were alive [2, 3].
- Genetic testing at diagnosis is essential; mutations such as IDH1 and FLT3 have their own specific drugs [1, 4, 5].
The story: from "there is no treatment" to new tablets
Acute myeloid leukaemia (AML) is a fast-moving disease seen mostly in older people. For years the standard treatment was intensive chemotherapy in hospital, which many older people, or people with heart, kidney or lung disease, cannot tolerate. For these patients usually only a gentle drug such as azacitidine was left, which controlled the disease for a short time [2].
Then came venetoclax tablets, which remove a barrier that leukaemia cells use to escape dying. When this tablet was added to azacitidine, the number of patients reaching complete or near-complete remission rose from about 28 to 66 in every 100 [2]. Two years later, twice as many patients were alive with this combination as with azacitidine alone [3].
Mutations that change treatment
| Test result | What it means for treatment |
|---|---|
| IDH1 mutation | In patients who cannot tolerate intensive chemotherapy, ivosidenib tablets with azacitidine nearly tripled survival [4] |
| FLT3 mutation (in fit patients) | Adding a specific FLT3 tablet to chemotherapy lengthened survival [5, 6] |
| Other genetic results | They show how serious the disease is and whether a bone marrow transplant is needed [1] |
Some results take a few days; your doctor may adjust treatment accordingly.
What is treatment like?
- 1
Tests on day one
Blood count, a bone marrow sample and genetic tests (including FLT3, NPM1 and IDH) [1].
- 2
Choosing the intensity of treatment
Based on age, physical fitness, other illnesses and the patient's wishes: intensive chemotherapy or gentler treatment with venetoclax [1].
- 3
Monthly cycles
Azacitidine is injected for a few days each month and venetoclax is a daily tablet; regular blood tests are needed because blood counts fall [2].
- 4
Preventing infection
A fever during this time is an emergency (low blood counts and infection).
When should I call my doctor?
Report a temperature of 38 °C or higher, shivering, new bleeding or bruising, breathlessness or confusion straight away; with this treatment low blood counts and infection are common [2].
Frequently asked questions
My mother or father is over 75; is treatment worthwhile?
Yes, many older people benefit from gentler treatment with venetoclax; the main study was in patients aged 75 or over or with other serious illnesses [2]. The decision takes physical fitness and the patient's wishes into account.
Does this treatment get rid of the disease completely?
For most older people the aim is longer control of the disease and a better life; in a group of patients, remission lasts for years [3].
For physicians
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ELN 2022: genetic classification at diagnosis (FLT3, NPM1, IDH1/2 and others); in patients unfit for intensive treatment, HMA + venetoclax [1]. VIALE-A: median OS 14.7 versus 9.6 months (HR 0.66), CR+CRi 66.4% versus 28.3% [2]; 43-month follow-up HR 0.58 and 2-year OS 37.5% versus 16.9% [3]. AGILE (IDH1): ivosidenib + azacitidine, median OS 24.0 versus 7.9 months [4]. RATIFY and QuANTUM-First in fit patients with FLT3 [5, 6]. Doses: venetoclax + azacitidine.
Scientific evidence
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Scientific evidence
6 itemsDiagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN
Long-term follow-up of VIALE-A: Venetoclax and azacitidine in chemotherapy-ineligible untreated acute myeloid leukemia
Ivosidenib and Azacitidine in IDH1-Mutated Acute Myeloid Leukemia
Midostaurin plus Chemotherapy for Acute Myeloid Leukemia with a FLT3 Mutation
Quizartinib plus chemotherapy in newly diagnosed patients with FLT3-internal-tandem-duplication-positive acute myeloid leukaemia (QuANTUM-First): a randomised, double-blind, placebo-controlled, phase 3 trial
Azacitidine and Venetoclax in Previously Untreated Acute Myeloid Leukemia
Read more
Related cancer types
Treatment guides
References
6 referencesShow all references, 6 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2
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- 5
- 6Quizartinib plus chemotherapy in newly diagnosed patients with FLT3-internal-tandem-duplication-positive acute myeloid leukaemia (QuANTUM-First): a randomised, double-blind, placebo-controlled, phase 3 trial
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
Printed from the website; the full and up-to-date version: https://drdabiri.com/en/articles/aml-treatment-older-adults/
