Unfit AML Treatment — RACP Adult Medicine MCQ

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ModerateHaematologyUnfit AML TreatmentRACP Adult Medicine

A 68-year-old man with myelodysplastic syndrome transforms to AML. He is not fit for intensive chemotherapy due to significant comorbidities. What is the standard first-line treatment for unfit patients with AML?

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Correct answer: A — Azacitidine (hypomethylating agent)

For older/unfit patients with AML who are not candidates for intensive chemotherapy, azacitidine 75 mg/m² SC for 7 days every 28 days is the standard treatment (AZA-001 trial showed OS benefit). Venetoclax + azacitidine combination (VIALE-A trial) has shown superior OS and is increasingly used as front-line treatment for unfit AML patients. Low-dose cytarabine is an inferior alternative. Best supportive care alone is reserved for patients who decline or cannot tolerate any active treatment.

Reference: eTG – 2025 – Haematology; NCCN – 2025 – AML Guidelines