【医学课件】 Acute and Chronic Myeloid Leukemia.ppt

Recent Risk Stratification Favorable Down syndrome-related (esp. if 4 y.o.) APL with t(15;17) or variant Cytogenetics: inv(16), t(8;21) Molecular: NPM1, CEBPA Unfavorable t-AML, MDS-related AML Cytogenetics: -7, 5q-, abn(3q) Molecular: FLT3/ITD (high allelic ratio) Primary induction failure (5% blasts after course 2) Intermediate: everything else Separate protocols Update: incorporation of MRD Intermediate Risk Sub-classified into favorable or unfavorable according to end-course 1 flow cytometric MRD centralized laboratory, using +/- threshold of 0.1% Grouped with “traditional” favorable/unfavorable groups Adapted from: Loken, et al. Blood. 120(8): 1581 Current Risk Stratification Favorable (Low Risk, LR) Down syndrome-related (esp. if 4 y.o.) APL with t(15;17) or variant Cytogenetics: inv(16), t(8;21) Molecular: NPM1, CEBPA Intermediate with end course 1 MRD negative Unfavorable (High Risk, HR) t-AML, MDS-related AML Cytogenetics: -7, 5q-, abn(3q) Molecular: FLT3/ITD (high allelic ratio) Primary induction failure (5% blasts after course 2) Intermediate with end course 1 MRD positive Separate protocols Therapy Know which drug combinations are most effective in the treatment of acute myeloid leukemia Know that high-dose cytarabine is effective in the treatment of acute myeloid leukemia Know the role of CNS prophylaxis in the treatment of acute myeloid leukemia Know the evidence against the use of extended maintenance therapy for AML Know the indications for allogeneic HSCT in AML Know the various components of prophylactic and acute supportive care for children with acute myeloid leukemia receiving treatment Current Standard Therapy Remission induction 2 courses of intense chemotherapy (Ara-C, Doxo, Etoposide); high risk of invasive infection; CR rate ~ 75-80% Current protocol “switches” 2nd induction course to mitoxantrone/ HD Ara-C for HR patients Post-remission consolidation BMT All HR with best donor (matched sib preferred, MUD/UCB donors acceptable) No