NCCN Issues Extensive Updates to Acute Myeloid Leukemia Guideline

02/09/18

The National Comprehensive Cancer Network (NCCN) updated their induction and consolidation treatment recommendations for low-risk and high-risk acute myeloid leukemia (AML).

Multiple regimens were removed from the treatment induction and consolidation page for low-risk disease, including induction with ATRA plus daunorubicin and cytarabine; consolidation with arsenic trioxide, then ATRA plus daunorubicin; induction with ATRA plus higher-dose daunorubicin and cytarabine; and consolidation with daunorubicin plus cytarabine, then cytarabine plus daunorubicin. All assessment language in treatment dosing recommendation was removed.

Multiple regimens were added to the preferred section of the treatment induction for high-risk disease recommendations. Among these were induction with ATRA plus arsenic trioxide and gemtuzumab ozogamicin; consolidation with arsenic trioxide plus ATRA and gemtuzumab ozogamicin in some cases; induction with ATRA plus higher-dose arsenic trioxide and gemtuzumab ozogamicin; and consolidation with ATRA plus arsenic trioxide and gemtuzumab ozogamicin in some cases.

For patients with high-risk AML and cardiac issues, a few induction regimens have been added to the algorithm. Gemtuzumab was added to the first regimen of ATRA plus arsenic trioxide induction and arsenic trioxide plus ATRA consolidation. Multiple other ATRA induction regimens were added here, as well as multiple ATRA consolidation regimens.

Similarly, extensive changes were made to the algorithms for APL, patients aged less than 60 years, patients aged less than 60 years after standard-dose cytarabine induction re-induction, post-remission therapy for patients aged less than 60 years, patients aged at least 60 years, patients aged at least 60 years after standard-dose cytarabine induction, and post-remission therapy for patients aged at least 60 years.

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In the section for therapy for relapsed or refractory disease, a sub-section for clinical trials was added, as were categories for therapy for AML with IDH-2 mutation and therapy for CD33-positive AML. Enasidenib was added as a regimen to AML with IDH-2 mutation and gemtuzumab ozogamicin was added as a regimen to CD33-positive AML.—Zachary Bessette