Remission

Leukaemic myeloblasts in AML require cytotoxic agents which are highly toxic to normal marrow cells.

• an example of most commonly used combination therapy is - an anthracycline + cytarabine
• treatment is scheduled to exploit the slower regeneration time of leukaemic cells compared to normal cells
• commonly, aplasia of the bone marrow results which may take 2-3 weeks to recover
• intensive supportive care is essential because of the myelosuppression.
• all material necessary for diagnostic tests should be harvested before commencing chaemotherapy
• emergency leukapheresis may be required before induction chemotherapy in patients who present with excessive leukocytosis (2)

Induction chaemotherapy should be started as soon as (or preferably with minimal delay) the diagnostic work-up has been completed (1). Retrospective data have suggested that a delay of beyond 5 days to initiate therapy may have an adverse impact on the treatment outcome (1).

It is important to identify patients for allogeneic stem-cell transplantation early during induction (2).

Induction therapy in acute promyelocytic leukaemia (APL) should be complemented with all-transretinoic acid (ATRA) (2).

Patients who fail to respond to one or two cycles of therapy is categorised as refractory (2).

Reference:

• (1) 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.
• (2) 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.