Treatment of acute myeloid leukaemia

The national Institute for Clinical Excellence has recommended that

• patients with AML should be managed by a Haemato-Oncology Multidisciplinary Team serving a population of 500 000
• induction therapy should only be carried out in centres treating at least five patients per annum with induction chemotherapy with curative intent (1)

The most important threat to a patient is from

• complications of the disease at presentation
• myelosuppression - due to both the disease process and remission induction chemotherapy
• resistant/relapsing disease (1)

The objective of treatment is to produce and maintain complete remission (CR), which is considered to be the only currently accepted approach to AML cure (2). Treatment of AML is organised as:

• stabilisation of the acutely unwell patient
• induction of remission
• postremission therapy
• supportive care

Remission induction is attempted using a combination of cytotoxic agents anthracycline (eg, daunorubicin, idarubicin or anthracenedione mitoxantrone) and cytarabine (3).

• however this therapy will lead to myelosuppression and possibly severe infection
• major infection may be a major limiting factor in trying to achieve complete remission and the patient may be treated prophylactically with antibiotics

Bone marrow transplantation is often undertaken either following induction of remission or after relapse.

Supportive care is indicated in patients with poor performance status and considerable co-morbidity, as well as elderly patients not eligible for curative treatment (4).

Reference:

• (1) British Committee for Standards in Haematology et al.Guidelines on the management of acute myeloid leukaemia in adults. Br J Haematol. 2006;135(4):450-74.
• (2) Jabbour EJ, Estey E, Kantarjian HM. Adult acute myeloid leukemia. Mayo Clin Proc. 2006 Feb;81(2):247-60.
• (3) Döhner H et al. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010;115(3):453-74.
• (4) Fey M, Dreyling M; ESMO Guidelines Working Group. Acute myeloblastic leukemia in adult patients: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2009;20 Suppl 4:100-1.