Late-stage leukemias in aging populations: a public health call for integrated and personalized care models

Late-stage leukemias in older adults present a complex interplay of adverse disease biology, age-related vulnerabilities, and health care system challenges. Aging populations face unique clinical and public health burdens, including frailty, comorbidities, and limited access to specialized care, which complicate standard leukemia management. This narrative review synthesizes current evidence on late-stage acute and chronic leukemias in aging populations, highlighting age-specific biological features, therapeutic options, supportive-care considerations, and integrated care strategies. A structured literature search of PubMed, Scopus, Web of Science, and Google Scholar (2000-2025) was conducted using key terms including "<i>late-stage leukemia</i>," "<i>elderly AML/ALL/CLL/CML</i>," "<i>geriatric assessment</i>," and "<i>integrated care</i>." Eligible publications included clinical trials, observational studies, reviews, and policy documents focusing on adults aged ≥60 years. Evidence was synthesized narratively to provide an integrative perspective. Late-stage leukemias in older adults are characterized by higher prevalence of adverse genetic profiles, increased treatment-related toxicity, and reduced tolerance to intensive regimens. Age-adapted therapeutic strategies - including hypomethylating agents, targeted therapies, immunotherapies, and tyrosine kinase inhibitors - can improve outcomes when combined with comprehensive geriatric assessment and supportive care. Integrated care models incorporating multidisciplinary teams, early palliative interventions, and patient-centered decision-making optimize functional status, quality of life, and health care utilization. Effective management of late-stage leukemia in older adults requires personalized, multidisciplinary approaches informed by disease biology, geriatric assessment, and patient priorities.