NCCN临床实践指南_急性髓性白血病(2019.V3)英文版
128页1、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 Co
2、mprehensive 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 in
3、stitution 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 ne
4、oplasm 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 initiat
5、ion 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
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