EVALUATING NANOMEDICINE IN ACUTE MYELOID LEUKEMIA: THERAPEUTIC ADVANCES AND PATIENT-CENTERED OUTCOMES IN THE CONTEXT OF HEALTHCARE ACCESSIBILITY AND SOCIAL DETERMINANTS OF CANCER CARE

Abstract

Acute myeloid leukemia (AML) is an aggressive and biologically heterogeneous hematological malignancy in which therapeutic resistance, relapse, treatment-related toxicity, and persistent disease within the bone-marrow microenvironment continue to limit long-term outcomes. Molecularly directed therapies, venetoclax-based combinations, immunotherapeutic approaches, and liposomal formulations have expanded the therapeutic landscape, but treatment effectiveness remains dependent on disease biology, patient fitness, treatment tolerance, and access to specialized care. Nanomedicine has emerged as a potential strategy for addressing several of these limitations through controlled drug release, altered pharmacokinetics, combination delivery, cellular targeting, and bone-marrow-directed delivery. This narrative review examines the development of nanomedicine in AML while extending the discussion beyond drug-delivery efficacy to patient-centered outcomes, healthcare accessibility, and clinical translation. Evidence indicates that lipid-based, polymeric, biomimetic, and ligand-functionalized nanoparticles can improve delivery characteristics in preclinical AML models, while the clinical success of the liposomal cytarabine–daunorubicin formulation CPX-351 demonstrates that nanomedicine can reach routine clinical practice. However, most actively targeted AML nanoplatforms remain preclinical, and important barriers include biological heterogeneity, limited predictability of nanoparticle distribution in hematological malignancy, manufacturing complexity, regulatory uncertainty, cost, and inadequate patient-centered evidence. Quality of life, treatment burden, convenience, financial toxicity, geographical access, and equitable availability therefore need to become explicit considerations in nanomedicine development. Future AML nanomedicine research should integrate molecular patient selection, human-relevant models, standardized manufacturing, health-economic evaluation, patient-reported outcomes, and implementation science. Nanomedicine should consequently be evaluated not only according to whether it can deliver a therapeutic payload, but also according to whether that delivery produces meaningful, safe, accessible, and sustainable benefits for patients.