0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45
Acute Myeloblastic Leukemia 39■Renal failure may be due to hypovolemia, leukemic infiltration, uric
acid nephropathy
■Prophylactic platelet transfusions may be given if platelet count <10–
20,000/ul, or for bleeding. CNS bleeding is of particular concern
■DIC usually associated with APL
■HLA typing if patient is a candidate for Stem Cell Transplant (SCT)
■Severe neutropenia (<500 neutrophils/ul) with fever requires antibi-
otic therapy; surveillance cultures of throat, nasopharynx, blood,
skin, urine, and stool useful in induction therapy.specific therapy
■Chemotherapy and intensive supportive care are required
■Oncologic emergencies
➣Symptomatic leukostasis (CNS symptoms, renal failure, pul-
monary insufficiency)
➣Renal or liver failure due to leukemic infiltration may improve
rapidly with initiation of chemotherapy
➣Myeloblastomas resulting in organ dysfunction, such as spinal
cord compression, can be treated with local irradiation in addi-
tion to chemotherapy
➣DIC in association with APL requires urgent treatment.Induction Therapy
■APL (M3)
➣All-trans-retinoic acid (ATRA)+anthracycline-based chemothe-
rapy
➣At least 2 cycles of consolidation therapy after complete remission
➣Maintenance therapy recommended
■AML (adult)
➣Age <60, standard dose cytarabine+anthracycline (7+3); or
high-dose cytarabine+anthracycline or mitoxantrone
➣For age >60, standard-dose cytarabine+anthracycline
➣If history of MDS, clinical trial or SCT
➣If no remission, change therapyPost Remission Treatment
■For age <60, consolidation therapy with high-dose cytarabine, other
consolidation regimen, or SCT
■For age <60 and poor risk cytogenetics or prior MDS, clinical trial or
SCT
■For age >60, consolidation therapy with standard-dose cytarabine+
anthracycline or clinical trial