| Summary: | Simple Summary: Non-intensive AML treatments for older/frail patients have evolved considerably over the last decade, with an improved understanding of AML disease biology. This has led to a better understanding of risk in AML, and within the past two years, several different 'risk-stratification' systems have been developed. These systems enable clinicians to assess risk in individual patients, which in turn allows them to better define effective treatment approaches for different subtypes of AML. For example, there are several subgroups of NPM1-mutated AMLs with distinct risk types that may define specific treatment approaches. FLT3-mutated AML remains problematic, although it is anticipated that new drug approvals and new treatment approaches may alleviate this, at least in part. In the companion article in this issue of Current Oncology, 'Management of AML in Older Patients: An Updated Canadian Consensus', the authors have presented the third iteration of Canadian consensus guidelines on AML treatment in the elderly. While many aspects of AML treatment in the elderly have become better defined, some old questions remain and new questions and controversies have arisen. Here, we address three topics on which there is, at this time, no universal consensus. The first is the development and features of new risk-stratification systems specifically aimed at older, less-intensively treated patients. Several different systems now exist in parallel, potentially causing confusion amongst clinicians. The second topic is good-prognosis AML subtypes (IDH1- and NPM1-mutated AML). In the Canadian context, IDH1-mutated AML is of particular interest due to the new availability of ivosidenib in Canada. The third topic is adverse-risk AML subtypes (FLT3- and TP53-mutated AML). FLT3-mutated AML remains problematic, although it is anticipated that new drug approvals and measurable residual disease-based treatment approaches may alleviate this, at least in part. And in particular, TP53-mutated AML remains a major problem. Ongoing clinical trial enrollment is essential.
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