What is the treatment plan for a patient with Acute Myeloid Leukemia (AML)?

From the Guidelines

The treatment plan for a patient with Acute Myeloid Leukemia (AML) should involve intensive chemotherapy in two phases: induction and consolidation, with the "7+3" regimen being the standard induction therapy, consisting of cytarabine and an anthracycline such as daunorubicin, and consolidation therapy with high-dose cytarabine for patients with favorable cytogenetics, as recommended by the most recent guidelines 1. The treatment plan should be individualized based on patient age, performance status, cytogenetic profile, molecular mutations, and comorbidities.

• Induction therapy aims to achieve complete remission and usually consists of cytarabine (100-200 mg/m² continuous infusion for 7 days) combined with an anthracycline such as daunorubicin (60-90 mg/m² for 3 days) or idarubicin (12 mg/m² for 3 days), known as the "7+3" regimen.
• For patients with CD33-positive AML, gemtuzumab ozogamicin may be added to standard-dose cytarabine combined with daunorubicin, as recommended by the ESMO guidelines 1.
• Patients with intermediate or poor-risk disease may benefit from allogeneic hematopoietic stem cell transplantation after achieving remission, as suggested by the NCCN guidelines 1.
• For elderly or unfit patients, less intensive options include hypomethylating agents like azacitidine (75 mg/m² for 7 days every 28 days) or decitabine (20 mg/m² for 5 days every 28 days), as recommended by the ESMO guidelines 1.
• Targeted therapies are increasingly important, including FLT3 inhibitors (midostaurin, gilteritinib) for FLT3-mutated AML, IDH inhibitors (ivosidenib, enasidenib) for IDH-mutated disease, and venetoclax combined with azacitidine for older patients, as suggested by the NCCN guidelines 1.
• Supportive care with blood product transfusions, antimicrobial prophylaxis, and management of tumor lysis syndrome is essential throughout treatment, as emphasized by the ESMO guidelines 1.

From the FDA Drug Label

Response occurred in all MDS subtypes as well as in patients with adjudicated baseline diagnosis of AML. Azacitidine was administered subcutaneously at a dose of 75 mg/m 2 daily for 7 consecutive days every 28 days (which constituted one cycle of therapy). Patients continued treatment until disease progression, relapse after response, or unacceptable toxicity

The treatment plan for a patient with Acute Myeloid Leukemia (AML) using azacitidine is to administer the drug subcutaneously at a dose of 75 mg/m^2 daily for 7 consecutive days every 28 days. Treatment should continue until disease progression, relapse after response, or unacceptable toxicity 2.

• Key points:
  • Dose: 75 mg/m^2
  • Administration: subcutaneously
  • Duration: 7 consecutive days
  • Cycle: every 28 days
  • Treatment duration: until disease progression, relapse, or unacceptable toxicity

From the Research

Treatment Plan for Acute Myeloid Leukemia (AML)

The treatment plan for AML typically involves several steps, including:

• Remission induction chemotherapy with an anthracycline/cytarabine combination, followed by either consolidation chemotherapy or allogeneic stem cell transplantation, depending on the patient's ability to tolerate intensive treatment and the likelihood of cure with chemotherapy alone 3
• The standard treatment paradigm for AML is the "7+3" regimen, which consists of seven days of standard-dose cytarabine and three days of an anthracycline antibiotic, such as daunorubicin or idarubicin 4, 5

Chemotherapy Regimens

Different chemotherapy regimens have been studied, including:

• CPX-351, a chemotherapy formulation that is administered via less time-intensive IV infusion than the standard "7+3" continuous infusion regimen of cytarabine plus an anthracycline 6
• Induction regimens with cladribine, clofarabine, and lomustine have shown benefit in certain populations when added to a traditional backbone 4
• Midostaurin with "7+3" is the current standard of care for FLT3-mutant, younger AML patients 4

Novel Agents

Several novel agents have been approved for the treatment of AML, including:

• FLT3 inhibitor midostaurin
• IDH2 inhibitor enasidenib
• Liposomal cytarabine-daunorubicin CPX-351
• Revived antibody-drug conjugate gemtuzumab ozogamicin 7
• Other agents, such as Bcl-2 inhibitor venetoclax, CDK9 inhibitor alvocidib, and smoothened (SMO) inhibitor glasdegib, are undergoing clinical trials 7

Treatment Outcomes

The treatment outcomes for AML are improving with the incorporation of novel agents into the treatment plan, including:

• Higher response rates with lower intensity therapies, although these are less efficient at preventing relapses 5
• The only curative potential for poor-risk AML is still an allogeneic stem cell transplant 5