Management of persistent AML at day 14
1University of Washington, Fred Hutchinson Cancer Research Center, 825 Eastlake Ave E, Mailstop G3-200, Seattle, WA 98109, USA.
Abstract:
A common occurrence in management of acute myeloid leukemia (AML) is persistence of disease in the first post-treatment marrow, typically obtained 14-21 days after initiation of therapy. Here we will briefly discuss the prognostic significance of this finding and the relative values of morphology and multiparameter flow cytometry (MPFC) in assessing persistent AML. We will then consider the therapeutic options for persistent AML: (a) repetition of the first course of therapy, most frequently 3 days of daunorubicin or idarubicin followed by 7 days of cytarabine (ara-C) (hereafter "3 + 7"), (b) change to different chemotherapy, often "high-dose ara-C" (HiDAC) +/- other agents, (c) immediate allogeneic hematopoietic cell transplantation (HCT), or (d) HiDAC with HCT done in HiDAC-induced aplasia and using a conditioning regimen other than HiDAC. Since it is generally accepted that response to azacitidine or decitabine requires several months, the remarks here principally apply to patients not given these drugs, but rather given ara-C-containing therapy.
Insights
Persistent acute myeloid leukemia (AML) after initial therapy requires careful assessment. Evaluating residual disease using morphology and multiparameter flow cytometry guides treatment decisions for better outcomes.
Area of Science:
- Hematology
- Oncology
- Clinical Research
Background:
- Persistence of acute myeloid leukemia (AML) post-treatment is common.
- Early assessment of residual disease is crucial for prognosis.
Purpose of the Study:
- To discuss the prognostic significance of persistent AML.
- To compare morphology and multiparameter flow cytometry (MPFC) for assessing persistent AML.
- To review therapeutic options for persistent AML.
Main Methods:
- Discussion of prognostic significance.
- Comparative analysis of diagnostic methods (morphology vs. MPFC).
- Review of treatment strategies for persistent AML.
Main Results:
- Persistent AML in the first post-treatment marrow has prognostic implications.
- MPFC may offer advantages over morphology in detecting minimal residual disease.
- Several therapeutic strategies exist, including repeating induction chemotherapy, switching to high-dose cytarabine (HiDAC), or allogeneic hematopoietic cell transplantation (HCT).
Conclusions:
- Early detection of persistent AML is vital.
- The choice of therapy depends on disease status, patient factors, and treatment goals.
- Further research may refine optimal management strategies for persistent AML.
More Related Videos
07:38Intracellular Phosphoflow Cytometry of Acute Myeloid Leukemia Patient-Derived Xenotransplants
Published on: June 6, 2025
09:01Flow Cytometry to Estimate Leukemia Stem Cells in Primary Acute Myeloid Leukemia and in Patient-derived-xenografts, at Diagnosis and Follow Up
Published on: March 26, 2018