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Mutation testing in AML:
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ELN recommendations: Assessing fitness and eligibility for treatment in AML
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Conventional fitness assessments for AML have traditionally employed a binary classification as either fit or unfit, which limits the ability to tailor therapy to individual patient needs.1 The expanding number of novel treatment options for AML and the growing emphasis on individualized care necessitates a more comprehensive evaluation framework.1 The European Leukemia Net convened a panel of experts to develop clear guidelines and recommendations that consider clinical, biological, and patient-reported factors, ensuring treatment decisions are both medically appropriate and tailored to each patient's needs.1 Venditti et al.1 published their recommendations in Blood Advances. |
| Key learnings |
| A binary classification for fitness is no longer appropriate and should instead be seen as a spectrum of treatment eligibility based on clinical, biological, and social factors. QoL is an important consideration and should be monitored throughout treatment. |
| Age alone is not a sufficient indicator of fitness, as it is influenced by comorbidities, functional status, and overall health. Performance status, comorbidities, and geriatric assessment tools should be used to evaluate suitability for intensive therapy. |
| Patients should be assessed for eligibility for specific treatment regimens, with clear communication in non-technical language ensuring patient preference is a key determinant for treatment selection. |
| Fitness status should be reassessed at multiple points during treatment as patients may improve or deteriorate. Physicians should ascertain patient and caregiver expectations and goals to ensure informed and accurate treatment selection and shared decision making. |
Abbreviations: AML, acute myeloid leukemia; QoL, quality of life.
- Venditti A, Palmieri R, Maurillo L, et al. Fitness assessment in acute myeloid leukemia: recommendations from an expert panel on behalf of European Leukemia Net. Blood Adv. 2025. Online ahead of print. DOI: 10.1182/bloodadvances.2024013744
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