Typical treatment regimen for remission

Current standard in induction therapy is the (“3 + 7 regimen”)

• 3 days of an anthracycline (eg, daunorubicin, at least 60 mg/m2 [higher doses are being explored], idarubicin, 10-12 mg/m2, or the anthracenedione mitoxantrone, 10-12 mg/m2) and 7 days of cytarabine (100-200 mg/m2 continuous IV)
• has shown to be superior than other interventions and complete remission is achieved in 60% to 80% of younger adults (1)

Several randomised studies have compared daunorubicin with other types of anthracyclines but did not find any evidence that any agent is superior to daunorubicin at equivalent doses (1).

The addition of high-dose cytarabine (2–3 g/m2) to the induction therapy is not recommended (outside clinical trials) since there is no evidence that high doses improve clinical remission rates in these patients (1,2).

Addition of other cytotoxic agents such as thioguanine, etoposide, fludarabine, topotecan or modulators of multidrug resistance (MDR) in general for induction therapy have failed to show any increase in response rate (1)

• consolidation - given in three blocks; more courses may be required:
  • Ara-C - iv.; twice daily for 10 days }
  • daunorubicin - iv.; alternate days for 3 doses }
  • etoposide - iv.; daily for 5 days }
    
    
• amisacrine - iv.; daily for 5 days }
• Ara-C - iv.; continuous infusion }
• etoposide - iv.; high daily for 5 days }
  
  
• mitozantrone - iv.; daily for 5 days }
• Ara-C - iv.; intermediate dose twice daily for 3 } days

Reference;

• (1) Döhner H et al. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010;115(3):453-74.
• (2) British Committee for Standards in Haematology et al.Guidelines on the management of acute myeloid leukaemia in adults. Br J Haematol. 2006;135(4):450-74.