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Dealing with treatment uncertainty in elderly AML patients
markers during front-line therapeutic decision-making. The increasing use of next generation sequencing (NGS) technologies in AML will soon allow the identification of molecular markers in almost all patients, which will have various consequences. For patients with an actionable molecular marker,45 or with accurate genomics-based out- come prediction,46 NGS technologies will presumably reduce treatment uncertainty. Alternatively, for patients with a non-actionable marker or markers with unknown prognostic significance, NGS will likely add another level of uncertainty. Even though the MDM process cannot be
restricted to a computational process, novel methods such as decision-making tools supported by knowledge banks of matched genomic-clinical data47 are warranted. They will help physicians absorb large amounts of complex information and likely act as moderators of uncertainty. Pending the validation of such tools in daily practice, our study (which found a strong physician-effect on treatment decisions) should encourage the use of validated prognos- tic scores to rationalize the decision-making process in this setting.48 It should also encourage further exploration of the role of physicians’ attitudes in decision-making.
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