Internal Medicine

0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45

40 Acute Myeloblastic Leukemia

Relapse Therapy

■APL (M3)

➣Arsenic or Anthracycline+ATRA, followed by SCT or clinical trial

■AML

➣Early (<6 mo), clinical trial or SCT

➣Late (>6 mo), clinical trial, SCT, or repeat induction regimen

Special Situations

■Children should be treated on pediatric clinical protocols.

■CNS involvement requires intrathecal chemotherapy.

Side Effects & Contraindications

■Cytarabine

➣Nausea, vomiting, severe neutropenia with risk of life-threa-

tening infections, severe thrombocytopenia with risk of bleed-

ing, alopecia, liver dysfunction, cerebellar ataxia (high dose, age

related), rash, renal and neural toxicity less common

■Anthracycline

➣Nausea, vomiting, severe pancytopenia, cardiac dysfunction

(cumulative), alopecia, rash, tissue necrosis with extravasation,

mucositis

➣Dose reductions for severe renal, hepatic dysfunction

■ATRA

➣“Retinoic Acid Syndrome”

➣Respiratory distress, fever, weight gain, edema, effusions, hypo-

tension, renal failure

➣Prevent with chemotherapy, treat with high-dose corticosteroids.

➣Transient coagulopathy

➣Increased transaminases, triglycerides, bone pain

➣Headache

➣Contraindications

patient choice, debility from other medical problems

follow-up

During Therapy

■Regular assessment of blood counts, renal, liver function

■Bone marrow day 14–21 of induction therapy to assess response and

cellularity

■Bone marrow if relapse suspected

■Aggressive evaluation for fever and neutropenia.

■Consolidation and maintenance therapy: weekly to monthly blood

tests