Acute myelogenous leukemia (AML) is a rapid progressing malignancy of the myeloid progenitor cells, characterized by an uncontrolled proliferation of primitive blast cells replacing normal bone marrow cells. It is the most common form of acute leukemias in the United States. The median age of diagnosis is in the late 60s, with more than 50% of newly diagnosed cases occurring after 65 years of age, and approximately one-third of cases diagnosed after 75 years of age. Thus, as the population continues to age, the incidence of AML would be expected to rise.
This Journal of Clinical Pathways Supplement will focus on several key aspects of AML. First, Chadi Nabhan, MD, MBA, FACP, discusses the development of clinical pathways for AML (page 18). The AML population is very heterogenous, especially in the intermediate-risk category. A number of treatment options are available, and the most appropriate treatment options will be driven by both patient parameters and biomarker results. Development of a clinical pathway, first identifying the sub-populations, then identifying the most appropriate therapy, will go a long way to achieve optimal outcomes and control costs. In addition, clinical pathways will assist in driving supportive care in terms of providing consistent monitoring and appropriate interventions.
In his article, William J Cardarelli, PharmD, examines the clinical and economic burden of AML, including factors that contribute to poor prognosis and increased costs (page 28). While achieving remission is the first goal for treatment, patients must emerge from induction therapy in a stable enough condition to be able to tolerate the subsequent more intensive consolidation therapy to elicit a durable state of disease control. Treatment strategy will be influenced by various patient parameters, including the presence of biomarkers associated with AML. The importance of full karyotyping and cytogenic analysis for the most common abnormalities cannot be overemphasized in order to identify favorable or unfavorable risk groups, as well as identifying factors that contribute to risk stratification and prognosis. As in solid tumor cancers, the ability to identify mutations that carry prognostic impact is increasing with the use of molecular profiling. Finally, the burden and role of supportive care cannot be overlooked. In short, the clinical and economic burden of AML is significant.
Finally, we include an article from Belinda R Avalos, MD, and coauthors discussing the establishment of a specialized hematopoietic cell transplant program to acheive the aims of improving the quality of care while controlling costs (page 35). This article sheds light on the importance of novel approaches to providing care in order to improve value to patients and to the health care system as a whole.
The goal of this supplement is to provide a clearer perspective of the impact of AML upon the health care system, as well as the benefit of an AML clinical pathway.
