Welcome to Dr. Hamid Sanatinia's Virtual Headquarters
AML

Home

Should we treat or not???
Performace Status
Antiemetics
Growth Factors
Calculations
Chemo Precautions
TOXICITY CRITERIA
Antidepressants
Chemoprotection
MESNA
Dexrazoxane
Radioprotectants
Hypercalcemia of malignancy
Mucositis
Neutropenic Fever
Palliative Care
Radiation Oncology
<<<<<<<<<>>>>>>>>>
ALL
AML
Anal
Bladder Cancer
Brain Cancer
Breast (risk category)
Breast (adjuvant)
Breast (metastatic)
Breast (Xeloda)
Breast (hormonal)
Breast Cancer Genetics
Carcinoid
CLL
CML
COLON CANCER
Endometrial
Esophagous
Gastric
Gestational Trophoblastic Disease
Germ Cell (Ovary)
Hairy Cell Leukemia
Head/Neck
Head/Neck: ChemoRT abstracts
Head/Neck: Larynx
Head/Neck:Nasopharyngeal
Hodgkins
Islet Cell Tumors
Kidney
Liver
LUNG, NSC
Stage III Unresectable NSC Lung Cancer
Lung, SC
Lymphoma, Aggressive
Lymphoma, AIDS
Lymphoma, Burkitts
Lymphoma, CNS
Lymphoma, Cutaneous
Lymphoma, Indolent
Lymphoma, MALT
Lymphoma, Mantle cell
Lymphoma, Mediastinal B-Cell
Lymphoma, Refractory NHL
Melanoma
Mesothelioma
Multiple Myeloma
MDS
NHL
Ovarian
Pancreas
Prostate
Prostate (Hormonal)
Rectal Cancer
Sarcoma
Sarcoma, Ewing's
Sarcoma, Osteogenic
Skeletal Metastasis
Testicular Cancer
Thymoma
Thyroid Cancer
Waldenstrom's
Unknown Primary
<<<<<<<<<>>>>>>>>>
Molecular Genetics
Oncogenes, the list!
Immunoperoxidase stains
Tumor Markers
Bleomycin
Cisplatin
Etoposide
Ifosfamide
Methotrexate
Temazolamide
Mechanism of Action
Dose Modifications (Renal)
Dose Modifications (hepatic)
MDR

Chemotherapy choices for
1. AML
2. MDS-RAEBT
3. CML-blast crisis

Prognosis in AML based on cytogenetics

ARAC-DNR for 59 yrs. or younger


INDUCTION (7+3):
Cytarabine 100-200 mg/m2 CIV days 1-7
Daunorubicin 30- 45 mg/m2 IVB* days 1-3
*Daunorubicin dose is 30 mg/m2 for patients 60 years of age and older, and 45 mg/m2 for those under 60.

If leukemia is persistant, additional induction cycles are given:
Cytarabine 100 mg/m2 CIV days 1-5
Daunorubicin 30 or 45 mg/m2 IVB* days 1 & 2

Maintenance is complex; see reference for details.

Ref: Yates J, et al: Blood 60:454 (1982).

------------------------------------------------------------

Other 7+3 Regimen:

CYTARABINE 100 mg/m2 CI DAYS 1-7
IDARUBICIN 12 mg/m2 IV DAYS 1-3

CYTARABINE 100 mg/m2 CI DAYS 1-7
MITOXANTRONE 12 mg/m2 IV DAYS 1-3


------------------------------------------------------------

5+2 INDUCTION Regimen:
REF:Fisher DS. Knobf MT, Durivage HJ, eds. The Cancer Chemotherapy Handbook, 4th ed. St. Louis, MO:CV MOSBY 1993:314-315


CYTARABINE 100 mg/m2 CI DAYS 1-5
DAUNARUBICIN 45 mg/m2 IV DAYS 1-2

OR

CYTARABINE 100 mg/m2 CI DAYS 1-5
MITOXANTRONE 12 mg/m2 IV DAYS 1-2


------------------------------------------------------------
MTZ-ARAC

INDUCTION
Mitoxantrone 12 mg/m2 IV/30min days 1-3
Cytarabine 100 mg/m2 CIV days 1-7

if complete remission is not achieved, give:

Mitoxantrone 12 mg/m2 IV/30min days 1 & 2
Cytarabine 100 mg/m2 CIV days 1-5

REF: Arlin ZA: Novantrone: Worldwide Clinical Experience. Symposium, December (1988) (abstract).


------------------------------------------------------------

IDA-ARAC (Induction)

INDUCTION
Idarubicin 12 mg/m2 IV days 1-3
Cytarabine 100 mg/m2 CIV days 1-7

Repeat if luekemia persists on day 14 bone marrow.

CONSOLIDATION
Thioguanine 100 mg/m2 PO q12h X 10 doses
Cytarabine 100 mg/m2 IV q12h X 10 doses
Idarubicin 15 mg/m2 IV day 1 of each program

Repeat cycle every 21 to 28 days.

MAINTENANCE
Cytarabine 100 mg/m2 CIV days 1-5
Idarubicin 12 mg/m2 IV days 1 & 2

Repeat cycle every 13 weeks for 4 cycles.

Ref: Volger WR, et al: Semin Oncol 16:21 (1989).

------------------------------------------------------------

High Dose ARAC + DNR


Cytarabine 2000-3000 mg/m2 IV q12h
days 1-4 or 5
Daunorubicin 30- 45 mg/m2 IVB days 4-6

Ref: Herzig RH, et al: Blood 62:361 (1983).
Herzig RH, et al: J Clin Oncol 5:927 (1987).
Hoaglund HC, et al: JAMA 235:1888 (1976).

------------------------------------------------------------

High Dose ARAC for consolidation

Cytarabine 3000 mg/m2 IV q12h days 1, 3& 5


------------------------------------------------------------

CMA-676

Acetaminophen 650 mg orally and diphenhydramine 25 to 50 mg intravenously 15-30 minutes before infusion of CMA-676

CMA-676 9-mg/m2 2-hour intravenous infusion

Blood, Vol. 93 No. 11 (June 1), 1999: pp. 3678-3684
.
------------------------------------------------------------

ARSENIC
ARSENIC TRIOXIDE 0.15 mg/kg IV QD until remission, not to exceed 60 doses.

REF: Cell Therapeutics, INC, Trioxide package insert. 2000

------------------------------------------------------------

ATRA
All-trans-retinoic acid (ATRA) 45 mg/m2/day PO (1 or 2 divided doses)
Start 2 days before induction chemotherapy

REF:Blood 85:2643, 1995

------------------------------------------------------------

Journal of Clinical Oncology, Vol 20, Issue 15 (August), 2002: 3249-3253

Phase I Study of Temozolomide in Relapsed/ Refractory Acute Leukemia

20 patients (16 with AML, 2 with ALL, & 2 with CML in blastic phase) received 43 cycles of temozolomide. Patients began treatment at 2 different dose levels: 200 mg/m2/d x 7 days or 200 mg/m2/d x 9 days.

RESULTS: Prolonged aplasia was the dose-limiting toxicity, and the maximum-tolerated dose was 7 days of temozolomide. Overall treatment was well tolerated: hospitalization was required in only nine of 43 courses, & there were no treatment-related deaths. 2 patients obtained a complete response, and two others met criteria for complete response except for platelet recovery. Overall, 9 of 20 patients had a significant decrease in bone marrow blasts after temozolomide treatment.

CONCLUSION: Temozolomide was well tolerated & had significant antileukemic activity when given as a single agent. Further studies of temozolomide in hematologic malignancies are indicated

FAVORABLE PROGNOSIS CYTOGENETICS:
REF: Blood, Vol. 92 No. 7 (October 1), 1998: pp. 2322-2333

t(8;21)
t(15;17)
inv(16)
Whether alone or in conjunction with other abnormalities.

INTERMEDIATE PROGNOSIS CYTOGENETICS:
Normal
+8
+21
+22
del(7q)
del(9q)
Abnormal 11q23
All other structural/numerical abnormalities ie, Cytogenetic abnormalities not classified as favorable or adverse. Lack of additional favorable or adverse cytogenetic changes.

ADVERSE PROGNOSIS CYTOGENETICS:
5
7
del(5q)
Abnormal 3qComplex
Whether alone or in conjunction with intermediate-risk or other adverse-risk abnormalities.

------------------------------------------------------------

cllpicture2.gif

cllpicture2.gif

AMLCYTOGENETICS2.gif