What are treatment recommendations for relapsed or refractory acute myeloid leukemia (AML)?

Updated: Dec 05, 2018
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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See the list below:

  • Response rates depend on duration of first remission [27]
  • Patients in complete remission (CR) longer than 2y have a 60% chance of responding to front-line regimens
  • Patients in CR for 1-2y have a 40% chance of responding to front-line regimens; clinical trials are preferred
  • Patients in CR less than 1y are unlikely to respond to front-line regimens and should be referred for clinical trials
  • The prognosis for patients beyond first salvage is very poor [28]

Recommended chemotherapy regimens for relapsed or refractory disease

Mitoxantrone, etoposide, and cytarabine (MEC) [29] :

  • Etoposide 80 mg/m 2 IV over 1h plus
  • Cytarabine 1 g/m 2 IV over 6h plus
  • Mitoxantrone 6 mg/m 2; all three drugs should be given daily for 6d or

CLAG-M (cladribine, cytarabine, mitoxantrone, and filgrastim) [30] :

  • Cladribine 5 mg/m 2 IV over 2h daily for 5d plus
  • Cytarabine 2 mg/m 2 IV over 4h daily for 5d, with each dose starting 2h after cladribine plus
  • Mitoxantrone 10 mg/m 2 IV for 3d plus
  • Filgrastim (Neupogen) 300 µg for 6d starting 24h prior to chemotherapy or

FLAG-IDA (fludarabine, cytarabine, idarubicin, and filgrastim) [31] :

  • Fludarabine 30 mg/m 2/day IV over 30min on days 1-5
  • Cytarabine (Ara-C) 2 g/m 2/day IV over 4h; 4h after fludarabine on days 1-5
  • Idarubicin 10 mg/m 2/day IV on days 1-3
  • Filgrastim  5 µg/kg/day SC to begin on day 6 until neutrophil recovery

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