National Comprehensive Cancer Network

*For your reference, the announcement of the previous update (Version 1.2014) to the NCCN Guidelines for Acute Myeloid Leukemia, distributed on January 13, 2014, is included below:

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Acute Myeloid Leukemia. These NCCN Guidelines® are currently available as Version 1.2014.

• Evaluation for Acute Leukemia (AML-1)
  • Footnote “a” modified with the addition of the following sentence: “Multiplex gene panels and sequencing assays are available for the assessment of other molecular abnormalities that may have prognostic impact in AML (see Discussion).”

• Treatment for High Risk Acute Promyelocytic Leukemia (APL) (AML-3)
  • A new regimen was added:
    • Induction: ATRA 45 mg/m² (days 1–36, divided) + age-adjusted idarubicin 6–12 mg/m² on days 2, 4, 6, 8 + arsenic trioxide 0.15 mg/kg (days 9–26 as 2-h IV infusion)
    • Consolidation: ATRA 45 mg/m x 28 days + arsenic trioxide 0.15 mg/kg/day x 28 days for 5 wks x 1 cycle, then ATRA 45 mg/m² x 7 d every 2 wks x 3 + arsenic trioxide 0.15 mg/kg/day x 5 d for 5 wks x 1 cycle
    • The regimen is based on the following reference in footnote “u”: Iland HJ, Bradstock K, Supple SG, et al. All-trans-retinoic acid, idarubicin, and IV arsenic trioxide as initial therapy in acute promyelocytic leukemia (APML4). Blood 2012;120:1570-1580. A statement was added to this reference: “Prophylaxis with prednisone 1mg/kg/d for at least 10 d is needed for differentiation syndrome regardless of WBC at presentation.”

• Treatment for Low/Intermediate Risk APL (AML-4)
  • Footnote “aa” modified: “Lo-Coco F, Avvisati G, Vignetti G, et al. Retinoic acid and arsenic trioxide for acute promyelocytic leukemia. N Engl J Med 2013;369:111-121. Prophylaxis with prednisone 0.5mg/kg day 1 through completion of induction. If patient develops differentiation syndrome, change prednisone to dexamethasone 10 mg every 12 h until acute differentiation resolves, then return to previous prednisone dose.”

• Therapy for APL Relapse (AML-6)
  • Decision points added for “No prior exposure to arsenic trioxide or late relapse (³6 mo) after arsenic trioxide-containing regimen” and “early relapse (<6 mo) after ATRA or arsenic trioxide only (no anthracycline)” and “early relapse (<6 mo) after arsenic trioxide/anthracycline-containing regimen.”
  • For “early relapse (<6 mo) after ATRA or arsenic trioxide only (no anthracycline),” the following treatment recommendation was added: “Consider ATRA 45 mg/m² PO daily + idarubicin 12 mg/m² on days 2, 4, 6, 8 + arsenic trioxide 0.15 mg/kg IV daily until count recovery with marrow confirmation of remission.”

• Post-remission Therapy for patients <60 y of age with Acute Myeloid Leukemia (AML) (AML-10)
  • Intermediate Risk: “1-2 cycles of HiDAC consolidation followed by autologous HSCT” removed as a treatment option.

• Treatment for patients ³60 y of age with AML (AML-11)
  • “Favorable cytogenetic/molecular markers” changed to “Non-adverse cytogenetic/molecular markers.”
    • “preferred” added to idarubicin
    • Clofarabine removed as a treatment option
    • Low-intensity therapy clarified with “may be more appropriate for elderly patients or relatively unfit patients with comorbidities”
  • Therapy-related AML/prior MDS or unfavorable cytogenetics/molecular markers
    • “preferred” added to idarubicin
    • Clofarabine removed as a treatment option
    • Low-intensity therapy clarified with “may be more appropriate for fit patients who are candidates for subsequent HSCT”

• Salvage Chemotherapy Options (AML-F)
  • Clofarabine + cytarabine + GCSF changed to Clofarabine ± cytarabine + GCSF ± idarubicin with the following reference: Faderl S, Ferrajoli A, Wierda W, et al. Clofarabine combination as acute myeloid leukemia salvage therapy. Cancer 2008;113:2090-2096.