Goal for treating AML in hospital

1. wipe out leukemia with induction therapy
   • most patients start with 7+3, BM at day 14, 60% patients are free of disease, 40% with residual disease
   • start 5+2 if they have residual. Then wait another week and obtain another BM
   • after 5+2, 30% patients are free of disease, 10% still has residual disease
2. keep patient alive while their immune system is compromised
   • this is what the leukemia residents do
   • 85% of death are from infection, 10% from bleeding in brain
3. recover normal counts
   • usually 3 weeks after last week therapy
   • 7+3: day 28
   • 5+2: day 42
   • Platelets come back first, then WBC, then RBC last
4. cure person with consolidation
   • cure rate only 10% if does not do consolidation
   • High dose cytarabine (Hi-DAC): 6 dose, then stop.
     • Standard dose cytarabine need transport to carry into cell. Cells become resistant by not have transport protein. High dose passively diffuse across cell membrane so more difficult to develop resistance.
     • Side effects: also diffuses into tears and sweats. Eye sx, neurologic sx.
       • Conjunctivitis: eye drops
       • Cerebellar toxicity: perform finger to nose test daily
       • Acral Erythema

• Remission driven by age
  • < 60 years old: 95% live

  • 60 years old: 90% live

  • 80% all ppl go into remission
  • cytogenetics and molecular markers affect remission
  • poor prognosis:
    • p53, flt3, preceding MDS, preceding treatment induced AML
    • Try to do 1 dose consolidation and then get to SCT
• Cure rate also driven by age
  • < 60 years old: 35-40%

  • 60 years old: even less

• relapse: try Hi-Dac then get to SCT

ALL: gentler induction, but much longer maintenance (2-3 yrs) with MTX, vincristine.