Acute Myeloid Leukemia

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® NCCN Practice Guidelines in Oncology – v.1.2006 Acute Myeloid Leukemia Guidelines Index AML Table of Contents MS, References POSTREMISSION THERAPY ADDITIONAL THERAPY Second remission (morphologic) r Autologous HSCT (if PCR negative) or Allogeneic HSCT or Clinical trial First relapse p Arsenic trioxide q No remission Clinical trial or Allogeneic HSCT or Gemtuzumab ozogamicin pSee Supportive Care (AML-B). qAt the end of 2 cycles, if patient is not in molecular remission, consider allogeneic HSCT or clinical trial. rPatients unable to proceed to HSCT, maintenance arsenic for up to 4 cycles is an option. Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Back to AML Table of Contents Version 1.2006, 09/22/05 © 2005 National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN. AML-3
® NCCN Practice Guidelines in Oncology – v.1.2006 Acute Myeloid Leukemia Guidelines Index AML Table of Contents MS, References CLASSIFICATION TREATMENT INDUCTION b,p,v Age < 60, no antecedent hematologic disease High-dose cytarabine (HiDAC) w with either anthracycline (idarubicin or daunorubicin) or mitoxantrone (1 cycle) (category 2B) or Standard-dose cytarabine (100 mg/m2 continuous infusion (CI) x 7 days) with anthracycline (idarubicin or daunorubicin) or mitoxantrone (7+3) (may require 2 cycles) (category 2B) See Postinduction Therapy (AML-6) See Postinduction Therapy (AML-5) AML s Cytogenetics unknown at induction Age 60, good KPS Age < 60, antecedent hematologic diseaset or treatment-related secondary AMLu Clinical trial (preferred) or Standard-dose cytarabine (100 mg/m2 CI x 7 days) with anthracycline (idarubicin or daunorubicin) or mitoxantrone (7+3) (may require 2 cycles) (category 1) Clinical trial (incorporating either chemotherapy or low-intensity therapy) or Allogeneic HSCT x See Postinduction Therapy (AML-5) At any age, significant comorbidities which cause organ dysfunction not directly related to leukemia b Young adults may be eligible for pediatric trials with more intensive induction regimens and transplant options. pSee Supportive Care (AML-B). sPatients with blast counts > 50,000/mcL are at risk for tumor lysis and organ dysfunction secondary to leukostasis. Measures to rapidly reduce the white count include apheresis or hydroxyurea to lower the white count to < 50,000/mcL. Moreover, rapid institution of definitive therapy is essential. tPatients known to have recognized poor-prognosis cytogenetic abnormalities prior to treatment may be treated like patients with an antecedent hematologic disorder. Low-intensity clinical trial or Best supportive care uRare patients with favorable karyotypes [inversion 16, t(8;21), t(16;16)] may be candidates for standard induction therapy, or APL therapy for t(15;17). vSee Monitoring During Therapy (AML-D). wThe use of high-dose cytarabine outside the setting of a clinical trial is still controversial. While the remission rates are the same for standard- and high-dose cytarabine, two studies have shown a disease-free survival advantage for patients age 50 who received the high-dose therapy (category 2B). xThe benefit of induction chemotherapy prior to allogeneic HSCT versus immediate HSCT is unclear in patients with high grade MDS and low blast count AML evolving from MDS. If donor is available, patient may proceed directly to HSCT. Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Version 1.2006, 09/22/05 © 2005 National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN. AML-4
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Acute Myeloid Leukemia

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