Pharmacology

Goal of Therapy for AML: Complete

Remission
Bone marrow contains <5% blast cells
CBC are within normal limits
There are no signs and symptoms of
leukemia

Types of treatment
1. Chemotherapy
2. Radiation therapy
3. Hematopoietic stem cell transplant
(HSTC)
4. Supportive treatment

Phases of adult AML

Treatment
1. Remission induction therapy
- the goal is to clear the blood of
leukemia cells (blasts) and to reduce
the number of blasts in the bone
marrow

2. Post-remission therapy
-to kill the remaining leukemia
cells after induction therapy

Remission induction therapy

Anthracycline (daunorubicin,
idarubicin, mitoxantrone) for 3 days
Cytarabine for continous IV infusion
for 7 days
3+7 classic AML induction
chemotherapy
Patients who fail to attain Complete
Remission after two rounds of
chemotherapy should be treated with
allogeneic HSTC.

Post-remission therapy
1. Favorable-risk AML]
1. 4 cycles of High dose cytarabine (3g/m
q12 on days 1,3,5)

2. Intermediate-risk AML
1. 4 cycles of High dose cytarabine (3g/m
q12 on days 1,3,5) or
2. Allogenic HSCT

3. Adverse-risk AML
1. Allogenic HSCT

Treatment for APL

Remission induction Therapy
All-trans retinoic acid (45mg/m per
day orally until remission) +
anthracycline based chemotherapy
Addition of cytarabine decreases the
risk of relapse
All-trans retinoic acid + Arsenic
trioxide for patients who cannot
tolerate Chemotherapy

Treatment for APL

Post-remission therapy
All-trans retinoic acid + anthracycline
All-trans retinoic acid + cytarabine
Arsenic trioxide for 2 cycles; then All-trans
retinoic acid + anthracycline for 2 cycles
All-trans retinoic acid + Arsenic trioxide

All-trans retinoic acid and Arsenic

trioxide
May produce APL differentiation
syndrome
Fever, fluid retention, dyspnea, chest
pain, pulmonary infiltrates, pleural and
pericardial effusions, and hypoxemia.

In severe APL differentiation

syndrome, temporarily stop
treatment with All-trans retinoic acid
and or Arsenic trioxide and treat with
glucocorticoids.

Radiation therapy
To treat leukemia that has spread to
the brain, spinal fluid and or
testicles
Before a bone marrow or stem cell
transplant
Shrink tumor on specific sites on the
body
Reduce pain in an area of bone that
is invaded by leukemia

Supportive care
Adequate and prompt blood bank
support is critical to therapy.
Platelet transfusions to maintain
10,000/L
RBC transfusions to maintain >8g/dL

Supportive care
Prophylactic anti-infectious treatment
Wash hands often
Neutropenic diet
Avoid fresh flowers and plants
Avoid large crowds or sick people
Make sure people wash hands when
they come in contact with you
Take antibacterial, antifungal and
antiviral prophylactic drugs

Maraming Salamat po!