Updated NCCN Guidelines for AML Include Risk Stratification to Assist in Treatment Selection
The National Comprehensive Cancer Network (NCCN) recently updated the NCCN Guidelines for Acute Myeloid Leukemia (AML), the most common acute leukemia affecting adults. Noteworthy updates include the incorporation of risk stratification based on white blood cell count, the alternative to use cord blood in allogeneic stem cell transplants, and new treatment options for adults over the age of 60 with AML.
October 16, 2009
FORT WASHINGTON, PA — The National Comprehensive Cancer Network (NCCN) recently made updates to the NCCN Clinical Practice Guidelines in Oncology™ for Acute Myeloid Leukemia, a cancer that starts inside the bone marrow and the most common acute leukemia affecting adults. Among the updates to the NCCN Guidelines is the addition of risk stratification, based on white blood cell (WBC) count to assist with the selection of treatment for patients with acute promyelocytic leukemia (APL), a subtype of AML.
New pages were added to the NCCN Guidelines to address the therapy options for APL patients with low risk or high risk disease as defined by WBC count status. The updated NCCN Guidelines recommend that patients with APL who can tolerate anthracycline therapy should have their WBC count assessed prior to therapy to classify them as high risk, which constitutes having a WBC count greater or equal to 10,000, or low/intermediate risk, which is having a WBC count of less than 10,000.
The updated NCCN Guidelines note that APL should be treated according to one of the regimens established from clinical trials. They also emphasize the importance of using these regimens consistently and not mix induction from one with consolidation from the other.
For patients with AML who are candidates for an allogeneic stem cell transplant – a procedure in which a person receives blood-forming stem cells from a donor with matched tissue type– the updated NCCN Guidelines now list umbilical cord blood as an alternative source if an appropriate sibling or unrelated donor is not available.
Recommendations for induction chemotherapy for patients with AML consider age 60 as a therapeutic divergence point and therefore, the NCCN Guidelines consider patients older or younger than 60 years old separately. However, for older patients (>60 years) with AML, the updated NCCN Guidelines recommend that patient performance status, in addition to adverse features and comorbid conditions need to be considered when selecting treatment in addition to a patient’s chronological age alone.
In the updated NCCN Guidelines, 5-azacytidine (Vidaza®, Celgene Corporation) and decitabine (Dacogen®, Eisai Inc.), have been added as low intensity treatment options and clofarabine (Clolar®, Genzyme Corporation) as intermediate intensity treatment option for patients with AML who are 60 years or older. All these agents have a category 2B designation.
Although AML is a relatively rare disease, an estimated 12,810 new cases will be diagnosed in the United States in 2009, its incidence appears to be increasing as the population ages.
NCCN Clinical Practice Guidelines in Oncology™ are developed and updated through an evidence-based process with explicit review of the scientific evidence integrated with expert judgment by multidisciplinary panels of physicians from NCCN Member Institutions. The most recent version of this and all the NCCN Guidelines are available free of charge at NCCN.org.
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 23 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit NCCN.org.
The NCCN Member Institutions are:
- Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center
- City of Hope Comprehensive Cancer Center
- Dana-Farber/Brigham and Women's Cancer Center
Massachusetts General Hospital Cancer Center
- Duke Cancer Institute
- Fox Chase Cancer Center
- Huntsman Cancer Institute at the University of Utah
- Fred Hutchinson Cancer Research Center / Seattle Cancer Care Alliance
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
- Memorial Sloan-Kettering Cancer Center
- Moffitt Cancer Center
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
- Roswell Park Cancer Institute
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
- Stanford Cancer Institute
- University of Alabama at Birmingham Comprehensive Cancer Center
- UC San Diego Moores Cancer Center
- UCSF Helen Diller Family Comprehensive Cancer Center
- University of Colorado Cancer Center
- University of Michigan Comprehensive Cancer Center
- The University of Texas MD Anderson Cancer Center
- Vanderbilt-Ingram Cancer Center