Table 4 Summary scheme of anticancer therapy in relation to the type of patient whether or not eligible for intensive chemotherapy treatment
Patients eligible for intensive chemotherapy | |
|---|---|
Induction Therapy | |
Induction therapy “7 + 3” treatment (no age limit) | 3 days of Anthracycline (Daunorubicin 60 mg/m2 or Idarubicin 12 mg/m2 or mitoxantrone 12 mg/m2) and 7 days of continuous induction of Ara-C (100–200 mg/m2) |
FLT3 mutated patients | Addition to “7 + 3” regimen of FLT3 inhibitor Midostaurin and continued for at least 1 year after consolidation therapy |
CD33-positive patients | Addition to “7 + 3” regimen of GO recommended for favourable and intermediated genetic risk |
Patients with therapy related AML | CPX-351 gives better results compared to “7 + 3” regimen |
Elderly and adverse risk patients | Clinical trials and investigation therapy are encouraged |
Consolidation Therapy | |
Favourable genetic risk | Intermediate or high dose of Ara-C (1000–3000 mg/m2) every 12 h for 3 days per 2 to 4 cycles. |
Intermediate genetic risk | IDAC (1500 mg/m2) every 12 h for 3 days per 2 to 4 cycles. |
HDAC (3000 mg/m2) and autologous HSCT (in relation to individual risk of relapse, performance status, comorbidities, and patient preference) | |
Adverse genetic risk | Allogenic HSCT from matched-related or unrelated donor with same individual condition of autologous HSCT |
Patients NOT eligible for intensive chemotherapy | |
Ara-C | Low dose Ara-C (20 mg/m2) every 12 h for 1 to 10 days (not recommended for adverse genetic risk patients) |
Hypomethylating agents | Azacitidine (75 mg/m2) for 1 to 7 days |
Decitabine (20 mg/m2) for 1 to 5 days | |
Antibody drug conjugate | GO if favourable or intermediate genetic risk patients CD33 positive |
Best supportive care | Hydroxyurea for those patients with therapy related side effects |
Investigation therapy | Clinical trials and investigation therapy are strongly encouraged |