NCCN临床实践指南_急性髓性白血病(2019.V3)英文版

NCCN org Version 3 2019 05 07 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Acute Myeloid Leukemia Version 3 2019 May 7 2019 Continue Martin S Tallman MD Chair Memorial Sloan Kettering Cancer Center Eunice S Wang MD Vice Chair Roswell Park Cancer Institute Jessica K Altman MD Robert H Lurie Comprehensive Cancer Center of Northwestern University Frederick R Appelbaum MD Fred Hutchinson Cancer Research Center Seattle Cancer Care Alliance Vijaya Raj Bhatt MBBS Fred 374 2209 2221 The information obtained may have prognostic impact in AML may influence medical decision making regarding consolidation with chemotherapy versus an allogeneic hematopoietic stem cell transplant or determination for eligibility for clinical trial participation see Discussion If a test is not available at your institution consult the pathology team prior to performing the marrow evaluation about preserving material from the original diagnostic sample for future testing at an outside reference lab Peripheral blood may alternatively be used to detect molecular abnormalities in patients with morphologically detectable circulating leukemic blasts Circulating blasts from peripheral blood may alternatively be used to detect molecular abnormalities in patients with a minimum of 10 involvement by the myeloid neoplasm to prevent false negative results Footnote f modified Patients who present with isolated extramedullary disease myeloid sarcoma should be treated with systemic therapy Local therapy surgery radiation therapy RT or surgery rare cases may be used for residual disease See Principles of Radiation Therapy AML C Foonote g was revised and moved to AML 1 from AML 2 In patients with clinical and pathologic features of APL start all trans retinoic acid ATRA upon first suspicion of APL Early initiation of ATRA may prevent the lethal complication of bleeding If cytogenetic and molecular testing do not confirm APL discontinue ATRA and continue treatment as for AML All trans retinoic acid ATRA should be available in all community hospitals so appropriate therapy can be started promptly AML 2 APL Classification and Treatment Recommendation Foonote g was revised and moved to AML 1 Footnote h moved to AML 3 Several groups have published large trials with excellent outcomes However to achieve the expected results one should use the regimen consistently through all components and not mix induction from one trial with consolidation from another Footnote j removed New data suggest similar outcomes in patients with low or intermediate risk These risk groups are combined into one category in most treatment protocols also applies to AML 3A Updates in Version 1 2019 of the NCCN Guidelines for Acute Myeloid Leukemia from Version 3 2018 include Continued Updates in Version 2 2019 of the NCCN Guidelines for Acute Myeloid Leukemia from Version 1 2019 include AML 15 Age 60 y post remission therapy complete response 5th option was revised Dual drug liposomal encapsulation of daunorubicin 44 29 mg m2 and cytarabine 100 65 mg m2 IV over 90 min on days 1 and 3 x 1 cycle Updates in Version 3 2019 of the NCCN Guidelines for Acute Myeloid Leukemia from Version 2 2019 include The Discussion section was updated to reflect changes in the algorithm NCCN Guidelines Version 3 2019 Acute Myeloid Leukemia Version 3 2019 05 07 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion Printed by Maria Chen on 5 13 2019 1 09 00 AM For personal use only Not approved for distribution Copyright 2019 National Comprehensive Cancer Network Inc All Rights Reserved AML 3 Modified statement Bone marrow at day 28 to document morphologic remission before proceeding with consolidation 2nd regimen listed under Other Recommended Regimens category was moved to Preferred Regimens category AML 3A Footnote m modified with this reference Kutny MA et al Arsenic trioxide consolidation allows anthracycline dose reduction for pediatric patients with acute promyelocytic leukemia Report From the Children s Oncology Group Phase III Historically Controlled Trial AAML0631 J Clin Oncol 2017 35 3021 3029 also applies to AML 4A AML 5A Footnote n modified by adding this sentence QTc and monitoring and optimizing electrolytes are important in safe administration of arsenic trioxide also applies to AML 4A AML 5A AML 7 Footnote r modified If no evidence of morphologic disease ie absence of blasts and abnormal promyelocytes discontinue ATRA and arsenic trioxide can be discontinued to allow for peripheral blood recovery also applies to AML 4A AML 5A Footnote s modified by adding this sentence The presence of measurable molecular mark