ESMO guidelines for acute myeloid leukemia in adult patients

These updated guidelines aim to provide information on managing acute myeloid leukemia in adult patients.  

The occurrence of acute myeloid leukemia (AML) depends on the age of patients. Case numbers tend to rise significantly in patients aged 60 and over. Therapies for AML in adult patients have improved significantly over the years. These updated European Society of Medical Oncology (ESMO) Clinical Practice Guideline provides key recommendations on the treatment of AML in adult patients.  

All AML patients should be treated with standard induction and consolidation chemotherapy or non-intensive treatment. Induction treatment is the first treatment meant to cure a disease. Consolidation treatment is given after induction and is meant to kill any cancer cells that may be left in the body. Salvage treatment may be required if the initial treatment fails and patients have relapsed/refractory AML.   

For patients who are eligible for standard induction and consolidation chemotherapy, induction should consist of the 7+3 regimen involving cytarabine (Cytosar-U) and daunorubicin (Crubidine) and gemtuzumab ozogamicin (GO; Mylotarg).

In patients over 60 years, CPX-351 (liposomal daunorubicin and cytarabine) is recommended. This treatment should also be used for patients with genetic abnormalities such as FLT3-ITD- or FLT3-TKD-positive tAML or MRC-AML. 7+3 and midostaurin (Rydapt) are recommended for all other patients if they are FLT3-ITD- or FLT3-TKD-positive. 

For patients who are eligible for standard induction and consolidation chemotherapy, consolidation should consist of IDAC involving idarubicin (Idamycin) and cytarabine with or without GO. In patients aged 60 or older, consolidation should contain CPX-351 for tAML or MRC-AML and IDAC and midostaurin for FLT3-ITD- or FLT3-TKD-positive AML.  

For patients requiring non-intensive treatment, induction and consolidation should consist of HMA (hypomethylating agents) and venetoclax (Venclexta), if pretreated with HMA for MDS (myelodysplastic syndrome) or HMA or LDAC (low dose cytarabine), for all others.  

Salvage treatment for unresponsive AML should consist of allogeneic hemopoietic stem cell transplant (alloHSCT). AlloHSCT is when cells from a donor are transplanted into the patient to replace healthy cells killed during previous treatment. Salvage treatment for relapsed AML should consist of cytarabine or anthracycline-based re-induction. The recommended salvage treatment for patients who need non-intensive treatment is HMA or LDAC.   

These updated guidelines provided information on managing AML in adult patients.