Updates to NCCN guidelines for acute myeloid leukemia

This article aimed to outline updates to the National Comprehensive Cancer Network (NCCN) guidelines for the treatment of acute myeloid leukemia (AML). 

The NCCN Guidelines for AML provide recommendations for the diagnosis and treatment of AML. The recommendations are based on clinical trials that have led to improvements in treatment or new important information. The guidelines are intended to aid physicians with clinical decision-making. It is important to regularly update these guidelines according to the the most recent findings.

This article included updates to NCCN guidelines for adult patients with AML.  

It is recommended that patients with a family history of leukemia or other blood cancers should be evaluated for an inherited predisposition syndrome. Inherited predisposition syndrome is a genetic abnormality that increases the risk of developing cancer at an earlier age compared to the risk for the general population.  

Patients with low-risk acute promyelocytic leukemia (APL) who have low levels of mature blood cells after induction therapy (first-line treatment) should have a bone marrow biopsy and aspirate to differentiate bone marrow suppression from persistent disease. 

For patients with newly diagnosed AML, venetoclax (Venclexta) should be given together with hypomethylating agents (HMA) or low-dose cytarabine (LDAC; Cytosar-U). To reduce the development of tumor lysis syndrome (TLS) during the first cycle of treatment, patients should be hospitalized for the initiation, especially through dose escalation. TLS is a side effect of cancer therapy when a large number of cancer cells die and are released into the bloodstream over a short period of time. This can lead to many dangerous metabolic abnormalities.

For patients who prefer not to receive blood transfusions during treatment, it is recommended to consider a lower intensity induction therapy. It was also recommended that during treatment, measures should be taken to reduce blood loss and decrease the risk of bleeding. Iron and B12 vitamin supplementation, as well as bed rest and oxygen therapy, may be needed for some patients.

This article made updates to the guidelines for the treatment of patients with AML.