Treatment Considerations

According to the National Comprehensive Cancer Network (NCCN) guidelines, most initial treatment approaches for acute myeloid leukemia (AML) depend on1:

  • Age
  • History of prior myelodysplasia or cytotoxic therapy
  • Performance status

Treatment Considerations for Newly Diagnosed Patients1-3

Relapse/Refractory Treatment Considerations

Disease recurrence occurs in most patients with AML within 3 years after diagnosis. Determinants of outcome after relapse include4:

  • A short remission (ie, <6 months)
  • Adverse genetic factors
  • Prior allogeneic hematopoietic-cell transplantation (allo-HCT)
  • Older age
  • Poor general health status

At relapse, it is important to consider whether a patient is physically able to receive intensive salvage therapy. The patient’s goals should also figure into the decision-making process.4

Patients with AML who achieve complete response (CR) but later develop recurrent disease are described as having relapsed.

Diagnostic evaluation should include1:

  • Bone marrow aspirate and biopsy for morphology
  • Immunophenotyping
  • Cytogenetics
  • Molecular studies

In addition to the pretreatment evaluation, human leukocyte antigen (HLA) typing should be performed for patients who are candidates for allo-HCT. Decisions regarding therapy are influenced by5,6:

  • The likelihood of attaining CR5
  • Comorbid illnesses (including active infections)6
  • The presence of an HLA-matched donor and other eligibility for allo-HCT5

Refractory (resistant) disease is AML that failed to achieve CR with 1 or 2 initial courses of induction therapy. Resistance to induction therapy carries an unfavorable prognosis. Allo-HCT provides the highest likelihood of cure for patients with relapsed or refractory AML.1

The NCCN also recommends participation in clinical trials for patients with AML.1

References: 1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Myeloid Leukemia V.1.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed January 29, 2019. To view the most recent and complete version of the guideline, go online to The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. 2. Döhner H, Estey EH, Amadori S, et al. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010;115(3):453-474. 3. Eleni LD, Nicholas ZC, Alexandros S. Challenges in treating older patients with acute myeloid leukemia. J Oncol. 2010;2010:943823. 4. Döhner H, Weisdorf DJ, Bloomfield CD. Acute myeloid leukemia. N Engl J Med. 2015;373(12):1136-1152. 5. Othus M, Appelbaum FR, Petersdorf SH, et al. Fate of patients with newly diagnosed acute myeloid leukemia who fail primary induction therapy. Biol Blood Marrow Transplant. 2015;21(3):559-564. 6. Reagan JL, Fast LD, Safran H, et al. Cellular immunotherapy for refractory hematological malignancies. J Transl Med. 2013;11:150.