Acute Leukemias - Republican Scientific Medical Library
Acute Leukemias - Republican Scientific Medical Library
Acute Leukemias - Republican Scientific Medical Library
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Relapsed and Refractory <strong>Acute</strong> Myeloid Leukemia<br />
Syed Abutalib, Martin S. Tallman<br />
Contents<br />
4.1 Introduction .................... 57<br />
4.2 Prognostic Factors in Patients<br />
with Relapsed or Refractory AML .... 58<br />
4.2.1 Age ....................... 59<br />
4.2.2 Duration of CR1 and Cytogenetics . 59<br />
4.3 Treatment of Relapsed and Refractory<br />
AML .......................... 60<br />
4.3.1 Introduction ................. 60<br />
4.3.2 Conventional Cytotoxic<br />
Chemotherapy ............... 61<br />
4.3.3 Novel Agents Combined with<br />
Conventional Cytotoxic<br />
Chemotherapy ............... 61<br />
4.4 Hematopoietic Stem Cell<br />
Transplantation .................. 62<br />
4.4.1 Myeloablative Allogeneic Hematopoietic<br />
Stem Cell Transplantation . . 62<br />
4.4.1.1 In Relapsed AML ......... 62<br />
4.4.1.2 Relapse After Transplantation 62<br />
4.4.1.3 In Refractory AML ........ 63<br />
4.4.2 Non-Myeloablative Allogeneic<br />
Hematopoietic Stem Cell<br />
Transplantation ............... 63<br />
4.4.3 Autologous Hematopoietic Stem<br />
Cell Transplantation ........... 63<br />
4.5 Investigational Agents in Relapsed and<br />
Refractory <strong>Acute</strong> Myeloid Leukemia .. 64<br />
4.5.1 New Purine Analogs ........... 64<br />
4.6 Gemtuzumab Ozogamicin .......... 64<br />
4.6.1 Novel Alkylating Agents ........ 65<br />
4.6.2 Targeted Agents ............. 66<br />
4.7 Relapsed and Refractory <strong>Acute</strong><br />
Promyelocytic Leukemia .......... 66<br />
4.7.1 Introduction ................ 66<br />
4.7.2 Treatment of Relapsed and Refractory<br />
APL ...................... 66<br />
4.7.3 Studies with Arsenic Trioxide .... 67<br />
4.7.4 Studies with Hematopoietic Stem<br />
Cell Transplantation in Relapsed <strong>Acute</strong><br />
Promyelocytic Leukemia ........ 68<br />
4.7.5 Gemtuzumab Ozogamicin<br />
in Relapsed <strong>Acute</strong> Promyelocytic<br />
Leukemia .................. 69<br />
4.7.6 Central Nervous System (CNS) Relapse<br />
in <strong>Acute</strong> Promyelocytic Leukemia . 70<br />
4.7.7 Treatment of CNS Relapse ...... 70<br />
4.7.8 Strategies to Detect Early Relapse<br />
inAML .................... 70<br />
4.8 Summary ...................... 71<br />
References ......................... 71<br />
4.1 Introduction<br />
Despite effective initial therapy, the majority of adults<br />
with acute myeloid leukemia (AML) who achieve a complete<br />
remission (CR) eventually relapse and usually<br />
within 2 years. Furthermore, approximately 20% of patients<br />
never achieve first complete remission (CR1). In<br />
these settings, alternative treatment strategies have limited<br />
efficacy and allogeneic hematopoietic stem cell
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