What are the recommendations for induction therapy to treat acute myeloid leukemia (AML)?

Updated: Dec 05, 2018
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Answer

The combination of cytarabine with an anthracycline or anthracenedione is recommended. [2, 3, 4, 5] Note the following:

  • Cytarabine 100-200 mg/m2 continuous IV infusion for 7d plus

  • Idarubicin 12 mg/m2/day for 3d or daunorubicin 60-90 mg/m2/day for 3d

  • Follow-up bone marrow to assess remission is typically done 7-14d after completion of induction chemotherapy, except in patients with acute promyelocytic leukemia (APL) (see APL guidelines) [6]

Fixed-dose combination cytarabine/daunorubicin liposomal for newly diagnosed therapy-related acute myeloid leukemia (t-AML) or AML with myelodysplasia-related changes (AML-MRC) is as follows:

  • First cycle: Daunorubicin 44 mg/m²/cytarabine 100 mg/m² liposome IV on days 1, 3 and 5
  • Second cycle: Daunorubicin 44 mg/m²/cytarabine 100 mg/m² liposome IV on days 1 and 3 if needed; only for patients who do achieve remission with first induction cycle

Regimens combining high-dose cytarabine with anthracycline/anthracenedione are as follows [7, 8] :

  • Cytarabine 2-3 g/m2 q12h for 3d plus  idarubicin 12 mg/m2/day for 3d for one cycle or

  • Cytarabine 2-3 g/m2 q12h for 3d plus  daunorubicin 45-60 mg/m2 day for 3d for one cycle [6]

For newly diagnosed AML that is FLT3 mutation positive, midostaurin may be included, as follows:

  • Cytarabine 200 mg/m 2 IV on days 1-7 plus  daunorubicin IV 60 mg/m 2/day on days 1-3 plus  midostaurin 50 mg PO BID on days 8-21 of each 28-day cycle for up to two induction cycles [9]

Cladribine-based therapy is as follows:

  • Cytarabine 200 mg/m2 continuous infusion for 7d plus  daunorubicin 60 mg/m2 for 3d plus cladribine 5 mg/m2 for 5d [10]


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