Missing the forest for the trees.

With new therapies becoming available at quicker rates than ever, it can be easy to miss the big picture. The acute myeloid leukemia composite model (AML-CM) is a new and improved prognostic tool proposed in JAMA Onc this week, and it aims to provide us with a quick and easy patient composite view. A retrospective analysis followed by prospective validation among 1100 AML patients across five institutions shows that a unique combo of comorbidities, age, and molecular risk factors best predict for 8-week and one-year mortalities. Why take the time to figure this out on the front end? Because seeing the forest is important when deciding how aggressively to treat a disease that confers 5-year survival rates of 5% for those 65-74 years and a mere 1.6% for those ≥75 years--cohorts which together comprise half of all AML patients. This new prognostic model, together with expected efficacy of treatment and considerations of financial toxicity, should inform joint decisions regarding appropriate care...which for most older AML patients should probably include early integration of palliative care.


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