Acute Myeloid Leukemia Treatment Guidelines

Introduction to AML Treatment

The European Society for Medical Oncology recommends the optimal treatment for AML consists of induction chemotherapy with an anthracycline combined with cytarabine, followed by consolidation therapy tailored to cytogenetic and molecular risk stratification, with allogeneic stem cell transplantation reserved for intermediate and high-risk patients in first remission 1, 2, 3.

The National Comprehensive Cancer Network suggests comprehensive molecular and cytogenetic profiling is mandatory to guide treatment decisions, including obtaining peripheral blood and bone marrow samples for morphology, cytochemistry, immunophenotyping, cytogenetics, and molecular analysis 1, 2, 3.
The American Society of Clinical Oncology recommends performing HLA typing of the patient and family members immediately to identify candidates for allogeneic stem cell transplantation 1, 2, 3.
The European Society for Medical Oncology advises assessing cardiac function with echocardiography in patients with cardiac risk factors or history of heart disease before anthracycline administration 1, 2, 3.

The National Comprehensive Cancer Network recommends for patients <65 years old and fit for intensive therapy, an anthracycline (daunorubicin 60-90 mg/m² IV days 1-3 OR idarubicin 12 mg/m² IV days 1-3) plus cytarabine 100-200 mg/m² continuous IV infusion days 1-7 (the "7+3" regimen) 1, 2, 3.
The American Society of Clinical Oncology suggests for FLT3-mutated AML, adding midostaurin 50 mg orally twice daily with food on days 8-21 of each induction and consolidation cycle to standard 7+3 chemotherapy is not recommended due to lack of evidence, however midostaurin is approved for this use 1, 2.

The European Society for Medical Oncology recommends for favorable-risk AML, chemotherapy alone without transplant, using high-dose cytarabine (1-3 g/m² every 12 hours on days 1, 3, 5) for 2-4 cycles 1, 2, 3, 5.
The National Comprehensive Cancer Network suggests for intermediate and high-risk AML, allogeneic stem cell transplantation in first remission, with patients with HLA-identical sibling donors proceeding to allogeneic transplant after achieving complete remission 1, 2, 3, 5.

The American Society of Clinical Oncology recommends complete remission criteria, including normal bone marrow cellularity, <5% blasts in bone marrow, morphologically normal hematopoiesis, and peripheral blood count recovery 1, 2, 4.

The European Society for Medical Oncology suggests for relapsed non-APL AML, patients in second remission should be considered for allogeneic transplant with matched unrelated donor 1, 2, 5.
The National Comprehensive Cancer Network recommends for relapsed APL, arsenic trioxide can induce remission even in ATRA-refractory disease 1, 2, 5, 6.

The American Society of Clinical Oncology advises AML should only be treated in specialized centers with full hematology and medical oncology services, close collaboration with bone marrow transplant unit, infectious disease expertise, adequate transfusion services, and psycho-oncology support 1, 2, 3, 4, 5.