Navigating Fitness, Induction Choices, and Early Bone Marrow Assessment

The experts explore how clinicians personalize induction therapy in AML by assessing patient fitness, biological risk factors, and early treatment response. The panel emphasizes that distinguishing between fit and unfit patients is no longer binary; instead, decisions increasingly incorporate individualized considerations such as cardiac function, functional status, cytopenia tolerance, comorbidity burden, and personal patient goals. The experts explain that although intensive induction regimens such as 7+3 remain appropriate for biologically favorable younger patients, many older adults or those with high-risk features may derive greater benefit from lower-intensity regimens, particularly those incorporating venetoclax or targeted agents.

A recurring theme is the importance of early bone marrow evaluation, typically around days 14 to 21, to determine whether cytopenias reflect therapeutic response versus resistant disease. Because venetoclax regimens can induce profound aplasia even in responders, marrow assessment guides decisions regarding when to resume therapy, how long to extend cycle intervals, and whether treatment modification is necessary. The panel notes that relying solely on peripheral blood counts can be misleading, increasing the risk of overtreatment or excessive delay.

The experts also discuss how patient-specific disease biology influences induction strategy. For example, those with NPM1 mutations, IDH1/2 mutations, or other targetable lesions may benefit from tailored regimens that integrate targeted therapies earlier in the course of treatment. In contrast, patients with particularly aggressive molecular features may require more intensive upfront approaches or accelerated transitions to transplant.

The panel highlights the growing complexity of therapeutic decision-making. Although an expanding therapeutic toolbox has improved outcomes, clinicians must balance efficacy, tolerability, and logistics when selecting the optimal induction approach. Ultimately, the goal is to use biological and clinical information synergistically to maximize each patient’s chance of remission and long-term survival.