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Living with cancer· Appointment prep

Appointment sheet: Acute myeloid leukaemia in older or unfit patients

One page to bring and write on: your details, the questions for Acute myeloid leukaemia in older or unfit patients plus your own, the words you may hear, what to bring, the treatments the standard of care names, and room for the answers and agreed next steps. What you type stays in this browser. Print it or save it as a PDF. New to all this? Start with the first 60 days. Orientation, not medical advice.

Tick the questions to print

All of this cancer's questions start ticked. Untick what does not apply; ticks are kept in this browser. .

Your own questions

Shared with the prep pack, so questions you add there appear here too.

Print or save as PDF

Use (or Ctrl+P, Cmd+P on a Mac). To keep a copy, choose Save as PDF as the destination in the print dialog. Only the sheet prints; the controls stay on screen. Your typed notes print where you typed them; empty fields print as ruled lines to write on.

Appointment sheet

Acute myeloid leukaemia in older or unfit patients

Prepared with OnCo (onco.cc/prep/aml-older-unfit/). Orientation, not medical advice; your team knows your case.

My details

Name
Date of appointment
Hospital and clinician
Who is coming with me

What I know, what is unclear, changes to discuss

Saved in this browser
What I know so far
What is unclear to me
Changes since last time

My questions

18 on the sheet
Newly diagnosed
  1. 1.What is my exact diagnosis, stage, and grade, and which tests established them?
  2. 2.Which biomarkers have been tested on my tumour (for example Performance status and geriatric assessment, Comorbidity index and organ function, ELN 2022 risk group, IDH1/2, NPM1, FLT3 and TP53 mutations, Measurable residual disease by flow cytometry), and what were the results?
  3. 3.Which subtype is my cancer, and does that change the recommended treatment?
  4. 4.Is germline (inherited) genetic testing recommended for me or my family?
Newly diagnosed, unfit for intensive chemotherapy
  1. 5.For my situation (newly diagnosed, unfit for intensive chemotherapy), which of the standard options do you recommend and why?
  2. 6.Am I a candidate for Venetoclax, Azacitidine, Decitabine or related drugs, and what side effects should I expect?
  3. 7.How do the results of VIALE-A and AGILE apply to someone like me?
Fit older patients, 60 to 75
  1. 8.For my situation (fit older patients, 60 to 75), which of the standard options do you recommend and why?
  2. 9.Am I a candidate for Cytarabine + anthracycline ('7+3'), CPX-351 (liposomal daunorubicin-cytarabine), Midostaurin or related drugs, and what side effects should I expect?
Not a candidate for any leukaemia-directed therapy
  1. 10.For my situation (not a candidate for any leukaemia-directed therapy), which of the standard options do you recommend and why?
  2. 11.Am I a candidate for Hydroxyurea (hydroxycarbamide), Glasdegib, Cytarabine, and what side effects should I expect?
Relapse after venetoclax-azacitidine
  1. 12.For my situation (relapse after venetoclax-azacitidine), which of the standard options do you recommend and why?
  2. 13.Am I a candidate for Gilteritinib, Ivosidenib, Revumenib, and what side effects should I expect?
Any stage
  1. 14.Are there clinical trials I could join, for example of Venetoclax, Shorter venetoclax courses in unfit AML, myeloMATCH, G8 geriatric screening tool?
  2. 15.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
  3. 16.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
  4. 17.I read that “How long venetoclax needs to be given, and whether MRD-negative patients can stop”. How does that affect my plan?
  5. 18.I read that “Whether fit older patients do better with venetoclax-azacitidine than with intensive chemotherapy”. How does that affect my plan?

The words I may hear

  • Hypomethylating agents (azacitidine, decitabine): Low-intensity chemotherapy that strips chemical 'off' switches (methyl groups) from DNA so silenced genes can be read again.
  • Tumour lysis syndrome (TLS): When a treatment kills cancer cells faster than the body can clear their contents, flooding the blood with potassium, phosphate and uric acid and injuring the kidneys and heart.
  • ELN 2022 risk classification: The three-tier system (favourable, intermediate, adverse) that decides how aggressively an adult with AML is treated and whether a transplant is recommended.

Tests and results to bring

Newly diagnosed, unfit for intensive chemotherapy: Venetoclax plus azacitidine (VIALE-A) or venetoclax plus decitabine; ivosidenib plus azacitidine for IDH1-mutated disease; targeted triplets in trials.

Biomarker results to ask for: Performance status and geriatric assessment, Comorbidity index and organ function, ELN 2022 risk group, IDH1/2, NPM1, FLT3 and TP53 mutations, Measurable residual disease by flow cytometry, Azole co-medication (venetoclax dose).

Scans and tests linked to this cancer: G8 geriatric screening tool.

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

The treatments I may be offered

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.

Answers and next steps

Saved in this browser
What I was told
Agreed next steps, dates and who to call