What is the role of chemotherapy in the treatment of erythroleukemia?

Updated: Dec 16, 2018
  • Author: Beata Holkova, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The management of AML (including the M6 subtype) usually constitutes induction chemotherapy and postinduction/consolidation chemotherapy. Cytarabine is the most active agent in the management of AML; therefore, various regimens are designed around this agent.

The regimen for induction therapy is the “7 + 3” regimen: Cytarabine at 100 mg/m2/d intravenously (IV) by continuous infusion on days 1-7 plus an anthracycline (idarubicin 12 mg/m2 or commonly used daunorubicin 45-60 mg/ m2) or anthracenedione (mitoxantrone 12 mg/ m2) ( IV) push on days 1-3. [14, 15]

The regimen for consolidation therapy includes 2 options. The high-dose ara-C (HiDAC) regimen includes cytarabine at 3 g/m2 IV q12h on days 1, 3, and 5 for 4 cycles. [16] The “5+2” regimen includes cytarabine at 100 mg/m2/d IV continuously infused on days 1-5 plus daunorubicin at 45 mg/m2 IV on days 1 and 2 for a total of 2 cycles. [17]

A bone marrow biopsy should be performed 14 days after induction therapy to assess remission status. If persistent blasts are noted, a second course (with dose-reduced “5 +2” regimen) is recommended. If marrow is hypoplastic, the second course is delayed until the bone marrow is recovered enough to clearly distinguish the type of recovery (ie, leukemic versus normal).

If the recovering marrow appears to have many immature cells, a wait-and-watch strategy is reasonable for as long as a week. Then, a repeat marrow biopsy is performed to clearly distinguish between relapse and remission.

Patients in whom 2 cycles fail are deemed primary refractory and should be considered for experimental therapeutic approaches.

Supportive care during chemotherapy treatment includes antiemetic prophylaxis, antiviral prophylaxis in herpes simplex – negative patients, and transfusion support.


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