title: Management of persistent AML at day 14.
abstract: A common occurrence in management of acute myeloid leukemia (AML) is persistence of disease in the first post-treatment marrow, typically obtained 14-21 days after initiation of therapy. Here we will briefly discuss the prognostic significance of this finding and the relative values of morphology and multiparameter flow cytometry (MPFC) in assessing persistent AML. We will then consider the therapeutic options for persistent AML: (a) repetition of the first course of therapy, most frequently 3 days of daunorubicin or idarubicin followed by 7 days of cytarabine (ara-C) (hereafter "3 + 7"), (b) change to different chemotherapy, often "high-dose ara-C" (HiDAC) +/- other agents, (c) immediate allogeneic hematopoietic cell transplantation (HCT), or (d) HiDAC with HCT done in HiDAC-induced aplasia and using a conditioning regimen other than HiDAC. Since it is generally accepted that response to azacitidine or decitabine requires several months, the remarks here principally apply to patients not given these drugs, but rather given ara-C-containing therapy.
authors.affiliation: University of Washington, Fred Hutchinson Cancer Research Center, 825 Eastlake Ave E, Mailstop G3-200, Seattle, WA 98109, USA. Electronic address: eestey@uw.edu.
authors.forename: Elihu
authors.initials: E
authors.lastname: Estey
mesh_terms: D064591:Allografts; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001374:Azacitidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003561:Cytarabine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003630:Daunorubicin / Q000627:therapeutic use; D000077209:Decitabine; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015255:Idarubicin / Q000627:therapeutic use; D015470:Leukemia, Myeloid, Acute / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors; D019172:Transplantation Conditioning
chemical_list: D003561:Cytarabine; C017162:cytaramin; D000077209:Decitabine; D001374:Azacitidine; D015255:Idarubicin; D003630:Daunorubicin
keywords: AML; HCT; HiDAC; MPFC; acute myeloid leukemia; allogeneic hematopoietic cell transplantation; ara-C; cytarabine; daunorubicin; day 14; high-dose ara-C; idarubicin; multiparameter flow cytometry; persistence