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Acute Myeloid Leukemia |
1 Division of Hematology, Niguarda Ca’Granda Hospital, Milan, Italy
2 Laboratory of Clinical Epidemiology, IRCCS Policlinico S.Matteo, Pavia
3 Functional Unit of Hematology, University of Florence, Hospital Careggi, Florence
4 Division of Hematology and Hematopoietic Stem Cell Transplantation, Hospital A. Cardarelli, Naples
5 Pediatric Hematology and Oncology, Fondazione, IRCCS Policlinico S.Matteo, University of Pavia
6 Istituto di Ematologia ed Oncologia Medica "Seragnoli", University of Bologna, Bologna
7 Hematology and Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Policlinico Monteluce, Perugia
8 Department of Cellular Biotechnology and Hematology, Policlinico Umberto I, University La Sapienza, Rome, Italy
Correspondence: Enrica Morra, MD, Division of Hematology, Niguarda Cà Granda Hospital, Milan, Italy, piazza Ospedale Maggiore 3, 20162 Milano, Italy. E-mail:enrica.morra{at}ospedaleniguarda.it
As many options are now available to treat patients with de novo acute myeloid leukemia, the Italian Society of Hematology and two affiliated societies (SIES and GITMO) commissioned project to an Expert Panel aimed at developing clinical practice guidelines for acute myeloid leukemia treatment. After systematic comprehensive literature review, the Expert Panel formulated recommendations for the management of primary acute myeloid leukemia (with the exception of acute promyelocytic leukemia) and graded them according to the supporting evidence. When evidence was lacking, consensus-based statements have been added. First-line therapy for all newly diagnosed patients eligible for intensive treatment should include one cycle of induction with standard dose cytarabine and an anthracycline. After achieving complete remission, patients aged less than 60 years should receive consolidation therapy including high-dose cytarabine. Myeloablative allogeneic stem cell transplantation from an HLA-compatible sibling should be performed in first complete remission: 1) in children with intermediate-high risk cytogenetics or who achieved first complete remission after the second course of therapy; 2) in adults less than 40 years with an intermediate-risk; in those aged less than 55 years with either high-risk cytogenetics or who achieved first complete remission after the second course of therapy. Stem cell transplantation from an unrelated donor is recommended to be performed in first complete remission in adults 30 years old or younger, and in children with very high-risk disease lacking a sibling donor. Alternative donor stem cell transplantation is an option in high-risk patients without a matched donor who urgently need transplantation. Patients aged less than 60 years, who either are not candidate for allogeneic stem cell transplantation or lack a donor, are candidates for autologous stem cell transplantation. We describe the results of a systematic literature review and an explicit approach to consensus techniques, which resulted in recommendations for the management of primary non-APL acute myeloid leukemia.
Key words: acute myeloid leukemia, clinical practice guidelines, stem cell transplantation.
Related Article
Haematologica 2009 94: 10-16.
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