Induction:
To induce remission.
Combination chemotherapy. Drugs generally used:
Intensification:
Consolidation
Cytarabine (Capizzi)
No Maintenance Phase
Length of treatment usually less than 1 year
Gemtuzamab Ozogamicin (Myelotarg)
- This drug was withdrawn from the market in 2010 because of toxicity and no clear benefit over previous therapies.
- Antitumor antibiotic (calecheamicin) linked to humanized IgG4 antibody against CD33 antigen
- Calecheamicin internalized into AML cells and causes double stranded DNA breaks and cell death
- Increased risk of veno-occlusive disease in transplant
- CD33 on normal and leukemic myeloid colony forming cells and on most AML cells, absent from non-hematopoietic tissue
Hematopoietic Stem Cell Transplantation
Allogenic HSCT was shown to be a reasonable and effective alternative to consolidation chemotherapy given after remission in the 1980s.
Patients with good risk features have no improvement in survival with HSCT, those with poor risk features need HSCT to improve survival. Those with standard risk features only undergo HSCT if matched related donor available.
For children with residual leukemia after induction or post-induction relapse, the only curative approach is transplantation.
