Leukemia
Also known as: ALL · AML · CLL · CML
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ASH Clinical Practice Guidelines on Acute Myeloid Leukemia in Older Adults
American Society of Hematology (ASH) · 2025 · 2025 update
Leukemia is a broad category, so this record uses the ASH guideline on acute myeloid leukemia in older adults as the single most representative current US guideline for the topic. It gives evidence-based recommendations on treatment decisions in older patients, a group where fitness for intensive therapy is the central question. ASH also lists a separate guideline on acute lymphoblastic leukemia in adolescents and young adults.
- Focuses specifically on treatment decisions for acute myeloid leukemia in older adults. source
- Published as a 2025 update with a stated summary of changes from the prior recommendations. source
- Full guideline appears in Blood Advances (doi 10.1182/bloodadvances.2025017934), with ASH implementation tools such as pocket guides and slide sets. source
Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN
European LeukemiaNet (ELN) · 2022
The European reference document for adult acute myeloid leukemia, selected as the single most representative current EU guideline for the broad leukemia topic. It sets out diagnostic work-up, the ELN genetic risk classification used to stratify patients, standardised response criteria, and treatment recommendations reflecting newer targeted agents.
- Contains a revised ELN genetic risk classification used widely to stratify adult acute myeloid leukemia. source
- Updates response criteria and incorporates measurable residual disease assessment and targeted agents such as FLT3, IDH1/IDH2 and BCL2 inhibitors. source
- Published in Blood in 2022 (volume 140, pages 1345-1377), lead author Hartmut Dohner; follows the 2010 and 2017 ELN editions. source
US vs EU key differences
- Scope differs sharply: the ELN document covers the whole AML pathway for adults — diagnosis, genetic risk classification, response criteria and treatment — while the ASH guideline is confined to treatment decisions in older adults with newly diagnosed AML. source
- Only the European document issues a genetic risk stratification: the 2022 ELN update revised its favourable/intermediate/adverse classification by adding myelodysplasia-related mutations to the adverse group, dropping the FLT3-ITD allelic ratio, and replacing biallelic CEBPA with in-frame bZIP-region mutations as a favourable marker. source
- The ELN recommendations define response criteria — including the new CR with partial haematologic recovery (CRh) category — and tie allogeneic transplant in first remission to measurable residual disease status and an estimated relapse risk above roughly 35-40%; the ASH older-adults guideline does not set response definitions or an MRD-based transplant threshold. source
- Version currency differs: the European recommendations date to 2022, whereas the ASH guideline for older adults was refreshed in 2025. source
What changed recently
- US2020 → 2025 update2025-12-01
The 2025 ASH panel retired the 2020 guideline's split between "intensive" and "non-intensive" therapy, framing recommendations instead around candidacy for antileukaemic therapy, and it now positions venetoclax-based combinations alongside conventional induction and post-remission therapy for older adults with newly diagnosed AML.
source ↗curation confidence 90% - EU2017 → 20222022-09-22
The 2022 ELN revision reworked genetic risk stratification: the FLT3-ITD allelic ratio was dropped as a classifier and FLT3-ITD without NPM1 mutation moved out of the adverse group, in-frame bZIP CEBPA mutations were accepted as favourable whether mono- or biallelic, and myelodysplasia-related gene mutations were added as adverse regardless of any prior MDS history.
source ↗curation confidence 90%
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