Management of AML with CD36 Expression

Initial Diagnosis and Risk Assessment

The American Society of Hematology recommends a complete diagnostic workup, including peripheral blood and bone marrow examination with morphology, cytochemistry, immunophenotyping, cytogenetic and molecular analysis, for patients with AML with CD36 expression 1
Risk stratification must consider both patient factors, such as age and performance status, and disease characteristics, including leukocyte count and molecular markers, for patients with AML with CD36 expression 1
Pre-treatment evaluation should include cardiac assessment with echocardiography for patients with cardiac risk factors and AML with CD36 expression 1

The standard induction therapy for AML with CD36 expression comprises 7 days of cytarabine and 3 days of an anthracycline, achieving complete remission in >85% of younger patients 2
For patients with hyperleukocytosis and signs of leukostasis, cytoreduction with hydroxycarbamide or IV/subcutaneous cytarabine may be necessary, while leukapheresis is not generally recommended 3

Bone marrow evaluation should be performed after hematological recovery from induction or between days 28-35 if recovery is lacking, and before each consolidation cycle, for patients with AML with CD36 expression 3
Complete remission is defined as normal bone marrow cellularity with <5% blasts and recovery of normal hematopoiesis, for patients with AML with CD36 expression 1

The consolidation strategy depends on risk stratification, with favorable risk patients receiving high-dose cytarabine-based chemotherapy consolidation, and intermediate/adverse risk patients considering allogeneic stem cell transplantation, for patients with AML with CD36 expression 1

Allogeneic stem cell transplantation is recommended for patients with intermediate or high-risk cytogenetics in first complete remission, and for those who achieved complete remission only after a second course of therapy, with AML with CD36 expression 1

Options for refractory or relapsed disease include clinical trials, intensive re-induction, allogeneic stem cell transplantation, and best supportive care, for patients with AML with CD36 expression 1
Intensive re-induction may be more successful with longer first remission duration, and allogeneic stem cell transplantation may be considered for patients in second remission, with AML with CD36 expression 4

After completion of intensive treatment, bone marrow morphology should be evaluated every 3 months for 24 months, and differential blood counts every 3 months for 5 years, for patients with AML with CD36 expression 3
Molecular MRD assessment should be performed every 3 months from bone marrow or every 4-6 weeks from peripheral blood for 24 months in patients with a molecular marker, with AML with CD36 expression 3

CD36 expression should be considered alongside other markers when determining eligibility for targeted therapies, such as gemtuzumab ozogamicin for CD33-positive AML, with AML with CD36 expression 3
Treatment should be conducted in centers with multidisciplinary expertise and adequate infrastructure, and clinical trials should be considered whenever possible, for patients with AML with CD36 expression 5

Anthracycline cumulative dose should be monitored due to cardiotoxicity risk, with cumulative doses >300 mg/m² associated with significant cardiac toxicity, for patients with AML with CD36 expression 2
Supportive care is essential and should include prophylaxis and management of tumor lysis syndrome, infection, bleeding, and thrombosis, for patients with AML with CD36 expression 3