Overview
Depending on the variant of the disease, patients are divided into 3 groups: A, B and C. Group A include patients with acute myeloid leukemia (AML) inv(16)(p13.1q22) or t(16;16)(p13.1;q22); CBFB-MYH11, group B - AML with t(8;21)(q22;q22.1); RUNX1-RUNX1T1, AML with normal karyotype with or without gene mutations (FLT3, NPM1, CEBPa) regardless of the allele ratio, and also AML with cytogenetic abnormalities not classified as those within groups A/C, group C - AML with myelodysplasia-related changes. Patients from group A receive treatment according to the scheme: 2 courses "7+3", 2 courses "FLAG", then - 6 courses of maintenance therapy according to the scheme "5+5". Patients from group B are given one course of "7+3". After that, their minimal residual disease (MRD) status is assessed. In case MRD negativity is achieved after the 1st course of "7 +3", randomization is carried out: branch 1
- therapy is similar to therapy for patients from group A (4 courses of induction and consolidation + 6 courses of maintenance chemotherapy (CT), allogeneic hematopoietic stem cell transplantation (allo-HSCT) is not planned), branch 2 - performing allo-HSCT should be done as soon as possible (before the start of maintenance CT is most desirable). If MRD negativity is not achieved after the 1st course of "7+3", the patient is given CT according to the standard program, followed by mandatory allo-HSCT. Patients from group C are treated either according to the "Aza-Ida-Ara-C" scheme, or according to the "Ven-DAC /AZA" scheme, followed by mandatory allo-HSCT.
Description
"7+3" regimen:
- Cytarabine 200 mg/m2 (IV continuous infusion over 24 hours), days 1-7
- Daunorubicin 60 mg/m2 (IV bolus), days 1-3
"FLAG" regimen:
- Fludarabine 25 mg/m2 (IV in 30 minutes), days 1-5
- Cytarabine 1500 mg/m2 (IV in 3 hours), days 1-5
- Granulocyte colony-stimulating factor 5 mcg/kg (subcutaneous injection), from day 6 until regression of cytopenia
"Aza-Ida-Ara-C" regimen:
- Azacitidine 75 mg/m2 (subcutaneous injection), days 1-3
- Idarubicin 3 mg/m2 (IV bolus), days 4-10
- Cytarabine 15 mg/m2 twice a day (subcutaneous injection), days 4-17
"Ven-DAC/AZA"
- Venetoclax 400 mg once daily (PO), days 1-28
- Either Azacitidine or Decitabine Azacitidine 75 mg/m2 (subcutaneous injection), days 1-7 Decitabine 20 mg/m2 (IV in 60 minutes). days 1-5
"5+5" regimen
- Cytarabine 50 mg/m2 twice a day (subcutaneous injection), days 1-5
- Mercaptopurine 30 mg/m2 twice a day (PO), days 1-5
Eligibility
Inclusion Criteria:
- Newly diagnosed, previously untreated AML;
- Age from 18 to 59 years;
- Somatic status - ECOG < 3.
Exclusion Criteria:
- previous chemotherapy for AML;
- pregnancy;
- relapses and refractory forms of AML;
- acute promyelocytic leukemia;
- blast crisis of chronic myeloid leukemia;
- de novo AML with t(9;22);
- AML transformed from MDS or MPN after treatment, for which a different protocol is provided;
- Blastoid plasmacytoid dendritic cell neoplasia (with the exception of cases when a small population of plasmacytoid dendritic progenitors is detected in the leukemic neoplasia).
- Undifferentiated acute leukemia