Blood Adv

ASH 2025: Updated guidelines for management of AML in older adults

December 10, 2025

The American Society of Hematology (ASH) 2025 guidelines for treating newly diagnosed acute myeloid leukemia (AML) in older adults emphasize a more nuanced, mutation- and fitness-guided treatment paradigm, reflecting advances such as venetoclax combinations and targeted inhibitors. The guidelines were published in Blood Advances to coincide with the ASH annual meeting.

Key clinical recommendations:

• Offer antileukemic therapy rather than best supportive care for eligible patients.
• For fit candidates, suggest conventional induction and postremission therapy over hypomethylating agents (HMA) or low-dose cytarabine (LDAC) monotherapy, and consider either conventional induction or HMA/LDAC combined with venetoclax.
• Recommend postremission therapy for patients who achieve remission after conventional induction and aren’t transplant candidates.
• For patients ineligible for conventional induction, suggest azacitidine over LDAC, five-day decitabine over ten-day decitabine, HMA plus venetoclax over HMA alone, and LDAC plus venetoclax over LDAC alone.
• For IDH-mutated AML, suggest azacitidine plus ivosidenib for IDH1, either HMA plus venetoclax or HMA plus ivosidenib for IDH1, azacitidine alone over azacitidine plus enasidenib for IDH2, and HMA plus venetoclax over HMA plus enasidenib for IDH2.
• Continue HMA- or LDAC-based therapy until progression or unacceptable toxicity rather than stopping after a fixed number of cycles.
• Add an FLT3 inhibitor to antileukemic therapy for patients with FLT3 mutations.
• Suggest allogeneic hematopoietic cell transplantation for patients in first remission with non-favorable prognosis.
• Make red blood cell transfusions available for patients no longer receiving antileukemic therapy.

Source:

Sekeres MA, et al. (2025, November 25). Blood Adv. American Society of Hematology 2025 guidelines for treating newly diagnosed acute myeloid leukemia in older adults. https://pubmed.ncbi.nlm.nih.gov/41321225/