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NCCN Flash Updates: NCCN Guidelines® and NCCN Compendium® for Acute Myeloid Leukemia

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs and Biologics Compendium (NCCN Compendium®) for Acute Myeloid Leukemia. These NCCN Guidelines® are currently available as Version 1.2020.

  • Formatting changes have taken place throughout the guideline. Please note that page names/numbers and headings have changed. "(Age ≥18 years)" was added to the header on all pages of the guideline
  • Evaluation for Acute Leukemia (EVAL-1)
    • The 6th bullet was modified: "...CEBPA (biallelic), IDH1, IDH2... (See AML-A)"
    • The phrase "and/or early referral to transplant center" was added to the end of bullet 8
    • Under Diagnosis, the AML pathway was modified: “Acute myeloid leukemia (AML): To appropriately stratify available intensive therapy options, expedite test results of molecular and cytogenetic analyses (maximum 3–5 days) for immediately actionable mutations (eg, CBF, FLT3 [ITD and TKD], NPM1, IDH1, IDH2)
      • For patients with highly proliferative cancers, one dose of intermediate dose cytarabine (1–2 gm) may be considered prior to receiving results
      • Appropriate management of leukocytosis is recommended while awaiting cytogenetic and molecular test results

For suspicion of blastic plasmacytoid dendritic cell neoplasm (BPDCN), see BPDCN-INTRO

  • A link was added: For the evaluation of BPDCN, see BPDCN-1
  • Footnotes for Evaluation for Acute Leukemia (EVAL-1A)
    • A footnote was modified: "A variety of gene mutations are associated with specific prognoses (category 2A) and may guide medical decision making (category 2B) (See AML-A). Other mutations, such as ASXL1, BCR-ABL, FLT3-ITD, FLT3-TKD, IDH1/2, NPM1, and PML-RAR alpha c-KIT and TP53 (See AML-A) may have therapeutic implications. The field of genomics in myeloid malignancies, and related implications in AML, are evolving rapidly. While the above mutations should be tested in all patients, multiplex gene panels and next-generation sequencing analysis may be used to obtain a more are recommended for a comprehensive prognostic assessment (Papaemmanuil E, Gerstung M, Bullinger L, et al. Genomic classification and prognosis in acute myeloid leukemia. N Engl J Med 2016;374:2209-2221; Lindsley RC, Mar BG, Mazzola E, et al. Acute myeloid leukemia ontogeny is defined by distinct somatic mutations. Blood 2015;125:1367-1376; Dohner H, Estey E, Grimwade D, et al. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood 2017;129:424-447.) (see Discussion)..."
  • APL Treatment Induction (Low Risk) (APL-2)
    • The phrase "(if contraindications to arsenic)" was added under "Other Recommended Regimen" to further clarify when this regimen should be used.
    • For preferred regimens, after induction, the follow-up phrase was revised: Bone marrow aspirate and biopsy at day 28–35 (if cytopenic) to document morphologic remission before proceeding with consolidation
  • Footnotes for APL Treatment Induction (Low Risk) (APL-2A)
    • A footnote was modified: For all inductions it is premature to do a marrow any sooner than day 28. Patients may be in cytogenetic remission but with residual molecular positivity at that time. The presence of measurable cytogenetic and molecular markers does not carry prognostic or therapeutic implications. (also on APL-3A and APL-4A)
  • APL Treatment Induction (High Risk) (APL-3)
    • Under Preferred Regimens, the 2nd pathway was modified: ATRA 45 mg/m2 in divided doses + arsenic trioxide 0.15 mg/kg/d IV + a single dose of gemtuzumab ozogamicin 9 mg/m2 may be given on day 1, or day 2, or day 3, or day 4
    • Under Preferred Regimens, the 3rd pathway was modified: ATRA 45 mg/m2 in divided doses + arsenic trioxide 0.3 mg/kg IV on days 1–5 of week 1 and 0.25 mg/kg twice weekly on weeks 2–8 (category 1)  + a single dose of gemtuzumab ozogamicin 6 mg/m2 may be given on day 1, or day 2, or day 3, or day 4
    • Under Consolidation Therapy, the 2nd pathway was modified: "...If ATRA or arsenic trioxide discontinued due to toxicity, a single dose of gemtuzumab ozogamicin 9 mg/m2 may be given once every 4–5 weeks until 28 weeks from complete response (CR)" (also for 3rd pathway)
  • Footnotes for APL Treatment Induction (High Risk) (APL-3A)
    • A footnote was removed: Lo-Coco F, Avvisati G, Vignetti M, et al. Front-line treatment of acute promyelocytic leukemia with AIDA induction followed by risk-adapted consolidation for adult patients younger than 61 years: results of the AIDA-2000 trial of the GIMEMA Group. Blood 2010;116:3171-3179.
  • APL Treatment Induction (High Risk) in Patients with Cardiac Issues (APL-4)
    • Low Ejection Fraction:
      • The 1st pathway was modified: ATRA 45 mg/m2 in 2 divided doses daily + arsenic trioxide 0.15 mg/kg IV daily + a single dose of gemtuzumab ozogamicin 9 mg/m2 on day 1
      • The 2nd pathway was modified: ATRA 45 mg/m2 in 2 divided doses daily + arsenic trioxide 0.3 mg/kg IV on days 1–5 of week 1 and 0.25 mg/kg twice weekly in weeks 2–8 (category 1)  + a single dose of gemtuzumab ozogamicin 6 mg/m2 on day 1
    • Prolonged QTc:
      • The pathway was modified: ATRA 45 mg/m2 in 2 divided doses daily + a single dose of gemtuzumab ozogamicin 9 mg/m2 on day 1
    • Consolidation Therapy:
      • The 1st pathway was modified: "...If ATRA or arsenic trioxide discontinued due to toxicity, a single dose of gemtuzumab ozogamicin 9 mg/m2 may be given once every 4–5 weeks until 28 weeks from CR" (also for 2nd pathway)
      • The 3rd pathway was modified: ATRA 45 mg/m2 in divided doses daily during weeks 1–2, 5–6, 9–10, 13–14, 17–18, 21–22, and 25–26. A single dose of Ggemtuzumab ozogamicin 9 mg/m2 may be given monthly until 28 weeks from CR
  • Footnotes for APL Treatment Induction and Consolidation Therapy (High Risk) (APL-4)
    • A footnote was added: For patients who have prolonged QTc as their sole comorbidity, gemtuzumab ozogamicin could be substituted for anthracycline.
  • APL Post-Consolidation Therapy and Monitoring (APL-5)
    • A phrase was modified: Monitor by PCR for up to 2 y after completion of maintenance therapy
    • A footnote was modified: "PCR should be performed on a marrow blood sample at completion of consolidation to document molecular remission. In patients receiving the ATRA/arsenic regimen, consider earlier sampling at 3–4 months during consolidation. Subsequent monitoring by PCR can be done with peripheral blood, although marrow is a more sensitive monitoring technique and may give earlier signs of relapse. Prior practice guidelines have recommended monitoring marrow blood by PCR every 3 mo for 2 y to detect molecular relapse. We continue to endorse this for high-risk patients, those >60 y of age or who had long interruptions during consolidation, or patients on regimens that use maintenance and are not able to tolerate maintenance..."
    • A footnote was modified: "To confirm PCR positivity, a second marrow blood sample should be done in 2–4 weeks in a reliable laboratory..."
  • APL Therapy For Relapse (APL-6)
    • A regimen in the 2nd pathway was modified: Arsenic trioxide 0.15 mg/kg IV daily ± ATRA 45 mg/m2 in 2 divided doses daily ± a single dose of gemtuzumab ozogamicin until count recovery with marrow confirmation of remission
    • A regimen in the 3rd pathway was modified: Arsenic trioxide 0.15 mg/kg IV daily ± ATRA 45 mg/m2 in 2 divided doses daily ± (anthracycline or a single dose of gemtuzumab ozogamicin) until count recovery with marrow confirmation of remission
  • Principles of Supportive Care for APL (APL-A) (formerly AML-D, 2 of 2)
    • A statement was added: "There are variations among institutions, but the following issues are important to consider in the management of patients with APL."
  • AML Age <60 y Treatment Strategies and Treatment Induction (AML-1)
    • Under Treatment Strategies, a category was removed from the 2nd pathway: Intermediate-risk cytogenetics and CD33+
    • Under Treatment Induction, the 2nd regimen in the 1st pathway was modified: Standard-dose cytarabine 200 mg/m2 continuous infusion x 7 days with daunorubicin 60 mg/m2 x 3 days and a single dose of gemtuzumab ozogamicin 3 mg/m2 (up to one 4.5 mg vial) given on day 1, or day 2, or day 3, or day 4; alternatively, three total doses may be given on days 1, 4, and 7 (CD33-positive) [also added to 4th pathway for intermediate-risk AML]
  • AML Age <60 y After Standard-Dose Cytarabine Induction/Re-Induction (AML-2)
    • The 3rd regimen in the 1st pathway was modified: Standard-dose cytarabine with daunorubicin and midostaurin (bone marrow aspirate and biopsy on d21) (FLT3 mutated [ITD or TKD]) (also applies to 2nd regimen in 2nd pathway)
    • The 4th regimen in the 1st pathway was modified: Dual-drug liposomal encapsulation of daunorubicin 44 mg/m2 and cytarabine 100 mg/m2  IV over 90 min on days 1 and 3 x 1 cycle (therapy-related AML other than CBF/APL, or patients with antecedent MDS/CMML, or cytogenetic changes that are consistent with MDS AML-MRC (preferred only if given in induction; bone marrow aspirate and biopsy on d14–21 days after start of therapy)
    • A phrase was modified: Bone Mmarrow aspirate and biopsy to document remission status upon hematologic recovery, including cytogenetics and molecular studies as appropriate. For measurable (minimal) residual disease (MRD) assessment, see AML-G
  • Footnotes for AML Age <60 y After Standard-Dose Cytarabine Induction/Re-Induction (AML-2A)
    • A footnote was modified: Begin alternate donor search (haploidentical, unrelated donor, or cord blood) if no appropriate matched sibling donor is available and the patient is a candidate for allogeneic HCT. For induction failure, alternative therapy to achieve remission is encouraged prior to HCT. (also on AML-3, AML-4A, AML-7A)
    • A footnote was modified: For regimens using high cumulative doses of cardiotoxic agents, consider reassessing cardiac function prior to each anthracycline/mitoxantrone-containing course. Karanes C, Kopecky KJ, Head DR, et al. A phase III comparison of high dose ARA-C (HIDAC) versus HIDAC plus mitoxantrone in the treatment of first relapsed or refractory acute myeloid leukemia: Southwest Oncology Group Study. Leuk Res 1999; 23:787-794. (also on AML-7A and AML-8A)
  • AML Age <60 y After High-Dose Cytarabine Induction (AML-3)
    • 1st pathway, an option was removed: Matched sibling or alternative donor HCT
    • AML Age <60 y Risk Status and Post-Remission Therapy (AML-4)
  • The 1st regimen in the 1st pathway was modified: HiDAC 3 g/m2 over 3 h every 12 h on days 1, 3, 5 (category 1) or days 1, 2, 3 x 3–4 cycles ± gemtuzumab ozogamicin 3 mg/m2 (up to one 4.5 mg vial) on day 1 x 2 cycles (CD33-positive)
  • The 2nd regimen in the 2nd pathway was modified: HiDAC 1.5–3 g/m2 over 3 h every 12 h on days 1, 3, 5 or days 1, 2, 3 x 3–4 cycles (also for the 2nd regimen of the 3rd pathway)
  • The 3rd regimen in the 2nd pathway was modified: HiDAC 1.5–3 g/m2 over 3 h every 12 h on days 1, 3, 5 or days 1, 2, 3 with oral midostaurin 50 mg every 12 hours on days 8–21 x 4 cycles (FLT3-mutated AML) (also for the 3rd regimen of the 3rd pathway)
    • The 4th regimen in the 3rd pathway was modified: Dual-drug liposomal encapsulation of daunorubicin 29 mg/m2 IV and cytarabine 65 mg/m2 over 90 min on days 1 and 3 x 1–2 cycles (therapy-related AML or patients with antecedent MDS/CMML or cytogenetic changes that are consistent with MDS AML-MRC) (preferred only if given in induction) (also applies to the 3rd regimen in the top pathway on AML-7 and the 5th regimen in the top pathway on AML-8)
    • Footnotes for AML Age <60 y Risk Status and Post-Remission Therapy (AML-4A)
  • A footnote was modified: Intermediate-risk patients who receive transplant shortly following gemtuzumab ozogamicin administration may be at risk for developing veno-occlusive disease sinusoidal obstruction syndrome (SOS). Wadleigh M, Richardson PG, Zahrieh D, et al. Prior gemtuzumab ozogamicin exposure significantly increases the risk of veno-occlusive disease in patients who undergo myeloablative allogeneic stem cell transplantation. Blood 2003;102:1578-1582. If transplant is planned, note that prior studies have used a 60- to 90-day interval between the last administration of gemtuzumab ozogamicin and stem cell transplant.
    • AML Age ≥60 y Treatment Strategies and Treatment Induction (AML-5)
  • Under Treatment Strategies, Intermediate-risk cytogenetics was removed from the 1st pathway (also removed from the 2nd pathway)
    • Under Treatment Induction, the 1st regimen in the 1st pathway was modified: Standard-dose cytarabine 200 mg/m2 continuous infusion x 7 days with daunorubicin 60 mg/m2 x 3 days and a single dose of gemtuzumab ozogamicin 3 mg/m2 (up to one 4.5 mg vial) given on days 1, 4, and 7 day 1, or day 2, or day 3, or day 4; alternatively, three total doses may be given on days 1, 4, and 7
    • Under Treatment Induction, the options for the 3rd pathway were modified: Therapy-related AML, Antecedent MDS/CMML, and Cytogenetic changes consistent with MDS AML-MRC
    • The 2nd regimen was removed: Standard-dose cytarabine (100–200 mg/m2 continuous infusion x 7 days) with idarubicin 12 mg/m2 or daunorubicin 60–90 mg/m2 x 3 days or mitoxantrone 12 mg/m2 x 3 days
    • Under Treatment Induction, the regimens in the 4th pathway (Unfavorable-risk cytogenetics [exclusive of AML-MRC]) were modified:
    • The 4th regimen was modified: Low-intensity therapy (azacitidine [category 2B], decitabine)
    • The 5th regimen was removed: Standard-dose cytarabine (100–200 mg/m2 continuous infusion x 7 days) with idarubicin 12 mg/m2 or daunorubicin 60–90 mg/m2 x 3 days or mitoxantrone 12 mg/m2 x 3 days
    • Under Treatment Induction, a regimen was added to the 5th pathway (Other recommended regimens for intermediate or poor-risk disease):
    • Standard-dose cytarabine 200 mg/m2 continuous infusion x 7 days with daunorubicin 60 mg/m2 x 3 days and a single dose of gemtuzumab ozogamicin 3 mg/m2 (up to one 4.5 mg vial) given on day 1, or day 2, or day 3, or day 4; alternatively, three total doses may be given on days 1, 4, and 7 (CD33-positive) (intermediate-risk AML)
    • Footnotes for AML Age ≥60 y Treatment Strategies and Treatment Induction (AML-5A)
    • A footnote was modified: The RATIFY trial studied patients aged 18–60 y. An extrapolation of the data suggests that older patients who are fit to receive 7+3 should be offered midostaurin since it seems to provide a survival benefit without undue toxicity. Schlenk RF, Weber D, Fiedler W, et al. Midostaurin added to chemotherapy and continued single-agent maintenance therapy in acute myeloid leukemia with FLT3-ITD. Blood 2019;133:840-851. (also on AML-7A and AML-8A)
    • AML Age ≥60 y Treatment Strategies and Treatment Induction (AML-6)
    • Under Treatment Induction, several regimens in the 1st pathway (AML without actionable mutations) were modified:
    • The venetoclax regimens were designated as "(preferred)" and moved to the top of the list of regimens
    • The "(preferred)" designation was removed from Low-intensity therapy (azacitidine, decitabine) (preferred), and this option was moved below the venetoclax regimens
    • Low-dose cytarabine changed from a category 2A to category 3
    • Gemtuzumab ozogamicin 6 mg/m2 on day 1 and 3 mg/m2 on day 8 (CD33-positive) changed from a category 2A to a category 2B
    • Under Treatment Induction, a regimen was added to the 2nd pathway (IDH1 mutant mutation):
    • Venetoclax-based therapy (same as above in combination with azacitidine, decitabine, or low-dose cytarabine) (also added to 3rd and 4th pathways: IDH2 mutant mutation and FLT3 mutant mutation)
    • Under Treatment Induction, a regimen in the 4th pathway (FLT3 mutation) was modified:
    • Low-intensity therapy (azacitidine, decitabine)  ±  + sorafenib (FLT3-ITD-positive) (also on AML-9)
    • Footnotes for AML Age ≥60 y Treatment Strategies and Treatment Induction (AML-6A)
    • A footnote was modified: Stein EM, DiNardo CD, Altman JK, et al. Safety and efficacy of AG-221, a potent inhibitor of mutant IDH2 that promotes differentiation of myeloid cells in patients with advanced hematologic malignancies: results of a phase 1/2 trial. Blood 2015;126(23):323; DiNardo CD, Stein AS, Fathi AT, et al. Mutant isocitrate dehydrogenase (mIDH) inhibitors, enasidenib or ivosidenib, in combination with azacitidine (AZA): Preliminary results of a phase 1b/2 study in patients with newly diagnosed acute myeloid leukemia (AML). Blood 2017;130:639. (also on AML-9A)
    • AML Age ≥60 y After Standard-Dose Cytarabine Induction (AML-7)
    • An option was added to the 1st pathway (Residual disease):
    • See Therapy for Relapsed/Refractory Disease (AML-H) (also added to the bottom pathway on AML-8)
    • Footnotes for AML Age ≥60 y Post-Remission Therapy (AML-8)
    • A footnote was modified: Patients who are deemed as strong candidates for HCT and who have an available donor should be transplanted in first remission. (also on AML-9A)
    • AML Age ≥60 y Post-Remission Induction Therapy (AML-9)
    • A statement was modified: Bone Mmarrow aspirate and biopsy to document remission status upon hematologic recovery (no earlier than 8–12 weeks) (timing is dependent on agent) For MRD assessment, see AML-G
    • A regimen was added to the top pathway (Response):
    • A single dose of gemtuzumab ozogamicin 2 mg/m2 on day 1 every 4 weeks for up to 8 continuation courses (CD33-positive) (category 2B)
    • AML Surveillance And Therapy For Relapsed/Refractory Disease (After Completion Of Consolidation) (AML-10)
    • This page was extensively revised.
    • A footnote was modified: Molecular profiling (including IDH1/IDH2, FLT3 mutations) is suggested as it may assist with selection of therapy and appropriate clinical trials (see Discussion). Molecular testing should be repeated at each relapse or progression.
    • A footnote was modified: Reinduction therapy may be appropriate in certain circumstances, such as in patients with long first remission (an exception is dual-drug liposomal encapsulation of cytarabine and daunorubicin). This strategy primarily applies to cytotoxic chemotherapy and excludes the re-use of targeted agents due to the potential development of resistance. If a second complete response is achieved, then consolidation with allogeneic HCT should be considered.
    • A footnote was removed: Transplant should only be considered in the context of a clinical trial or if a remission is achieved.
    • The title of AML-A was modified: European Leukemianet Risk Stratification By Genetics in Non-APL AML
    • A genetic abnormality was added to the Favorable Risk Category: Mutated NPM1 without FLT3-ITD or with FLT3-ITDlow
    • A footnote was modified: "...regardless of FLT3 allelic fractions, patients should be considered for bone marrow transplant hematopoietic stem cell transplant, though recent studies indicate that AML with NPM1 mutation and FLT3-ITD low allelic ratio may also have a more favorable prognosis..."
    • Evaluation And Treatment of CNS Leukemia (AML-B)
    • The statement after LP in the top pathway was modified: Positive by morphology or immunotype by flow cytometry
    • The statement after LP in the bottom pathway was modified: CSF positive by morphology or immunotype by flow cytometry
    • A footnote was modified: Screening LP should be considered at first remission before first consolidation for patients with monocytic differentiation, mixed phenotype acute leukemia, WBC count >40,000/mcL at diagnosis, extramedullary disease, or high-risk APL, or FLT3 mutations.
    • A footnote was modified: If equivocal, consider repeating LP with morphology or immunotype by flow cytometry to delineate involvement.
    • Principles of Supportive Care for AML (AML-D)
    • The 4th bullet was modified: Saline or s Steroid (or equivalent) eye drops should be administered to both eyes 4 times daily for all patients undergoing HiDAC therapy until 24 hours post completion of cytarabine.
    • Response Criteria Definitions for Acute Myeloid Leukemia (AML-E)
    • The 4th sub-bullet under the 4th bullet was modified: CRi - There are some clinical trials, particularly those that focus on the elderly or those with antecedent myelodysplasia, that include a variant of CR referred to as CRi.
    • Monitoring During Therapy (AML-F)
    • The 5th bullet under Post-remission therapy was modified: Patients with high-risk features, including poor-prognosis cytogenetics, therapy-related AML, prior MDS, or possibly 2 or more inductions to achieve a CR, are at increased risk for relapse and may should be considered for early alternate donor search, as indicated on AML-4
    • Measurable (Minimal) Residual Disease Assessment (AML-G)
    • A bullet was added to the top of the list: The role of MRD in prognosis and treatment is evolving. Participation in clinical trials is encouraged.
    • (Former) 1st and 4th bullets were combined: MRD in AML refers to the presence of leukemic cells below the threshold of detection by conventional morphologic methods. MRD is a component of patient evaluation over the course of sequential therapy. If the patient is not treated in an academic center, there are commercially available tests available that can be used for MRD assessment... The points discussed below are relevant to intensive approaches (induction chemotherapy) but have not been validated for other modalities of treatment.
    • A sub-bullet was added: There are distinct differences between diagnostic threshold assessments and MRD assessments. If using flow cytometry to assess MRD, it is recommended that a standard MRD assay is utilized, but, most importantly, that it is interpreted by an experienced hematopathologist.
    • (Former) 3rd bullet was modified: "Based on the techniques, the optimal sample for MRD assessment is either peripheral blood (PCR-based techniques) or the first pull or an early, dedicated pull of the bone marrow aspirate..."
    • (Former) 5th bullet was modified and reformatted:
    • A negative MRD result after induction, which depends on the technique used and the study, predicts a lower incidence of relapse.
    • MRD positivity is not proof of relapse. However, A a persistently positive MRD result after induction is associated with an increased risk of relapse.
    • For favorable-risk patients, if MRD is positive, consider a clinical trial or alternative therapies (eg, transplant, consolidation).
      • A sub-bullet was added: Patients with t(8;21) AML in remission may have a persistently positive PCR result, which may not indicate relapse.
  • After completion of therapy, “Molecular relapses” predict hematologic relapses within a 3- to 6-month timeframe.
  • (Former) 6th bullet was removed: There is no evidence that modifying clinical management based on a positive MRD (persisting after induction, or “relapsing” during or after therapy) modifies the outcome. There are 2 exceptions: APL and post allogeneic transplantation pre-emptive treatment with donor lymphocyte infusion (DLI) ± hypomethylating agents. For all other situations, there is no evidence supporting MRD assessment during the post treatment monitoring phase. The ELN still recommends monitoring CBF AML and APL for 2 years after completion of therapy.
  • Therapy For Relapsed/Refractory Disease (AML-H)
  • This page was modified and reformatted for consistency with AML-10
  • Under the new heading “Targeted therapy,” options were modified:
  • Therapy for AML with FLT3-ITD mutation:
    • An agent changed from category 2A to category 1: Gilteritinib (category 1)
    • Hypomethylating agents (azacitidine or decitabine) + sorafenib (FLT3-ITD mutation)
  • Therapy for AML with FLT3-TKD mutation
    • An agent changed from category 2A to category 1: Gilteritinib (category 1)
  • Under the heading “Less aggressive therapy,” a regimen was added: Venetoclax + HMA/LDAC
  • A footnote was modified: "...Molecular profiling should be considered if not done at diagnosis, or repeated to determine clonal evolution..."
  • Two references were added:
  • Aldoss I, Yang D, Aribi A, et al. Efficacy of the combination of venetoclax and hypomethylating agents in relapsed/refractory acute myeloid leukemia. Haematologica 2018;103:e404-e407.
  • DiNardo CD, Rausch CR, Benton C, et al. Clinical experience with the BCL2-inhibitor venetoclax in combination therapy for relapsed and refractory acute myeloid leukemia and related myeloid malignancies. Am J Hematol 2018;93:401-407.
  • A new section, Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN), was added to the guideline.

 

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