In a nutshell
This article provided treatment recommendations for patients with acute myeloid leukemia (AML).
The standard treatment for patients diagnosed with AML is a chemotherapy combination. Once there are no signs of AML (remission), patients are given post-remission chemotherapy to ensure it does not return. However, some patients do not respond to treatment (refractory), while the cancer returns in others (relapses). Additionally, some patients are not suitable for the initial chemotherapy because of age or other health conditions. Other treatment options are offered to these patients.
It is important to review treatment recommendations for patients with AML.
Methods & findings
For younger patients (under 65), idarubicin (Idamycin) or daunorubicin (Cerubidine) plus cytarabine (Cytosar-U) is recommended for initial treatment. Daunorubicin must be used at a high dose to be as effective as standard dose idarubicin.
The genetic mutations (abnormalities) of patients who achieve remission after treatment determine which post-remission treatment they should receive. Patients with favorable mutations should be given high dose cytarabine for post-remission therapy. Patients with intermediate or poor mutations should be given stem cell transplantation (SCT). If a matched donor is not available for SCT, patients may benefit from more chemotherapy using different drugs.
Patients who do not achieve remission should be given more chemotherapy cycles or replace one of the drugs to prevent drug resistance.
For older patients (over 65), lower doses of idarubicin or daunorubicin plus cytarabine are recommended for initial treatment. The lower dose reduces side effects in older patients suffering from other illnesses or having weaker organ function. Older patients may also benefit from therapies in clinical trials.
For most older patients who achieve remission, SCT is recommended as post-remission therapy depending on their suitability. Low dose cytarabine may also be offered as a post-remission treatment to those unsuitable for SCT.
There is no standard treatment for older patients who do not achieve remission or who relapse. Factors, such as genetic mutations, other health conditions, and duration of remission before relapsing should be considered. Treatment options include SCT, chemotherapy with different drugs as initial chemotherapy, or low dose cytarabine. Some patients may also be suitable to participate in clinical trials.
The chemotherapy treatments mentioned cause side effects such as low white blood cells. Patients with low numbers of white blood cells have a higher risk of developing infections. Patients, especially the older ones, can be offered granulocyte-colony stimulating factor or G-CSF (filgrastim; Neupogen) to prevent this side effect.
Another side effect, called tumor lysis syndrome (TLS), can lead to organ complications and failure if untreated. Approximated 17% of patients with AML develop TLS. Patients should be monitored for signs of TLS and treated if it arises.
Chemoimmunotherapy drug gemtuzumab ozogamicin (Mylotarg) can be used for patients with relapsed or refractory AML with the CD33 mutation.
The bottom line
This article provided treatment recommendations for patients with AML.
The fine print
This article was composed by a group in Japan and so the provided guidelines may not specifically match those used in other countries.
Published By :
International journal of hematology
Mar 23, 2020