AML and ALL
 

Favorable

t(8;21)(q22;q22), RUNX1-RUN1XT1 

inv(16)(q13.1;q22)/t(16;16)(p13.1;q22);CBFB-MYHT1

Mutated  NPM1 without FLT3-ITD (Normal Karyotype)

Mutated CEBPA (Normal Karyotype)

Intermediate- I

Mutated  NPM1 and FLT3-ITD (Normal Karyotype)

Wild type NPM1 and FLT3-ITD (Normal Karyotype)

Wild type NPM1 without FLT3-ITD (Normal Karyotype)

Intermediate -II

t(9;11)(p22;q23); MLLT3-MLL

Cytogenetic abnormalities not classified as favorable or adverse

Adverse

inv(3)(q21;q26.2) or t(3;3)(q21;q26.2), RPN1-EVI1

t(6;9) (p23;q34); DEK-NUP214

other t(v;11q23); MLL rearranged

-5 or del (5q-); -7; abn (17p); complex karyotype

New Recommended Standardized Reporting for Correlation of Cytogenetic & Molecular Genetic Data with Clinical Data in AML

International leukemia Panel recommendations (AML Review Blood 2010.pdf)

A Phase II Study of High Dose Lenalidomide as Initial Therapy for AML in Patients > 60 years old. ASH 2009 Abstr #842


All Patients (ITT)           

33 ORR= 30%

Patients completing 2 cycles

22 ORR = 45%

AML

de Novo           CR + iCR =26%

from MDS        CR + iCR =43%

Secondary        CR + iCR =33%

Cytogenetics

Poor                 CR + iCR =14%

Intermediate     CR + iCR =58%

Azacitidine (AZA) as First Line Therapy in AML: Results of the French ATU Program. ASH 2009 Abstr# 843


Median OS 37% at 1 year

AML post MDS, secondary or de Novo, OS curves not different.

AML Standard Induction

This paper is an argument to intensify the standard induction regimen for AML in the young (<60 years old) Anthracycline High Dose in AML NEJM 2009.pdf


In individuals aged 60 to 65 a better result was seen intensifying the daunorubicin dose too, but not in the older population. HD Daunorubicine AML Old NEJM 2009.pdf

NCCN Guidelines for AML

  1. II.Acute Lymphoblastic Leukemia

(No NCCN Guidelines Available)

Link to UptoDate here.

and ALL Papers in Public Folder access here

Common Regimens


MRC / ECOG E2293 for Adult ALL, Induction and Allobmt Results.


BFM Regimens. For adolescents and young adults under 30. Blood 2008.pdf.


GRAALL Regimen Pediatric inspired regimen, toxicity does not allow to be use in older than 45. JCO 2009 GRAAL Trial.pdf.


CALGB study 8811 For adults ver 30 years old

I. AML