Fitness in acute myeloid leukemia, state of the art and future directions

Acute Myeloid Leukemia (AML) is a complex disease whose outcome can be variably influenced by several clinical and biological factors. Although there is still no consensus on how to integrate these elements to best guide treatment choice, multiparametric models, commonly called fitness scores, have been developed to evaluate each patient’s ability to tolerate therapies. These models consider various risk factors, including disease biology, comorbidities, physical and cognitive function. To date, several scoring systems can be used to categorize patients on their fitness for intensive or non-intensive therapies. However, existing tools mainly focus on identifying patients suitable for conventional intensive chemotherapy and fail to address the complexities of less-fit patients who might benefit from innovative intensive, less-intensive, and even maintenance strategies. As treatment landscapes are in constant evolution, identifying intermediate level of fitness through recalibration of existing scores or development of new ones should be prioritized. Considering all the above, this review aims to report on the state of the art of fitness assessment in AML and discuss possible future directions on this topic.