Difference between revisions of "Acute myeloid leukemia"

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==7+3 Cytarabine & Daunorubicin ("Standard" or "conventional" dose)==
 
==7+3 Cytarabine & Daunorubicin ("Standard" or "conventional" dose)==
 
===Regimen===
 
===Regimen===
 +
Level of Evidence:
 +
<span
 +
style="background:#00CD00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase III</span>
 +
 
*[[Cytarabine (Cytosar)]] 100 to 200 mg/m2/day IV continuous infusion on days 1 to 7
 
*[[Cytarabine (Cytosar)]] 100 to 200 mg/m2/day IV continuous infusion on days 1 to 7
−
*[[Daunorubicin (Cerubidine)]] 45 mg/m2 IV once per day on days 1 to 3
+
*[[Daunorubicin (Cerubidine)]] 45 mg/m2 IV once daily on days 1 to 3
  
 
'''7-day course'''
 
'''7-day course'''
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===Regimen #1, Fernandez et al. 2009===
 
===Regimen #1, Fernandez et al. 2009===
 +
Level of Evidence:
 +
<span
 +
style="background:#00CD00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase III</span>
 +
 
*[[Cytarabine (Cytosar)]] 100 mg/m2/day IV continuous infusion on days 1 to 7
 
*[[Cytarabine (Cytosar)]] 100 mg/m2/day IV continuous infusion on days 1 to 7
−
*[[Daunorubicin (Cerubidine)]] 90 mg/m2 IV once per day on days 1 to 3
+
*[[Daunorubicin (Cerubidine)]] 90 mg/m2 IV once daily on days 1 to 3
  
 
'''7-day course'''
 
'''7-day course'''
  
 
===Regimen #2, Löwenberg et al. 2009 (HOVON/AMLSG/SAKK)===
 
===Regimen #2, Löwenberg et al. 2009 (HOVON/AMLSG/SAKK)===
 +
Level of Evidence:
 +
<span
 +
style="background:#00CD00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase III</span>
 +
 
*[[Cytarabine (Cytosar)]] 200 mg/m2/day IV continuous infusion on days 1 to 7
 
*[[Cytarabine (Cytosar)]] 200 mg/m2/day IV continuous infusion on days 1 to 7
−
*[[Daunorubicin (Cerubidine)]] 90 mg/m2 IV once per day on days 1 to 3
+
*[[Daunorubicin (Cerubidine)]] 90 mg/m2 IV once daily on days 1 to 3
  
 
'''7-day course'''
 
'''7-day course'''
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==7+3 Cytarabine & Idarubicin==
 
==7+3 Cytarabine & Idarubicin==
 
===Regimen===
 
===Regimen===
 +
Level of Evidence:
 +
<span
 +
style="background:#00CD00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase III</span>
 +
 
*[[Cytarabine (Cytosar)]] 100 to 200 mg/m2/day IV continuous infusion on days 1 to 7
 
*[[Cytarabine (Cytosar)]] 100 to 200 mg/m2/day IV continuous infusion on days 1 to 7
−
*[[Idarubicin (Idamycin)]] 12 mg/m2 IV once per day on days 1 to 3
+
*[[Idarubicin (Idamycin)]] 12 mg/m2 IV once daily on days 1 to 3
  
 
'''7-day course'''
 
'''7-day course'''
Line 54: Line 86:
 
==Cytarabine, Idarubicin, Sorafenib==
 
==Cytarabine, Idarubicin, Sorafenib==
 
===Regimen, Ravandi, et al. 2010===
 
===Regimen, Ravandi, et al. 2010===
 +
Level of Evidence:
 +
<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
''Regimen details are from the phase II part of the published trial.''
 
''Regimen details are from the phase II part of the published trial.''
 
*[[Cytarabine (Cytosar)]] 1500 mg/m2/day IV continuous infusion on days 1 to 4
 
*[[Cytarabine (Cytosar)]] 1500 mg/m2/day IV continuous infusion on days 1 to 4
 
**Patients older than 60 received: [[Cytarabine (Cytosar)]] 1500 mg/m2/day IV continuous infusion on days 1 to 3
 
**Patients older than 60 received: [[Cytarabine (Cytosar)]] 1500 mg/m2/day IV continuous infusion on days 1 to 3
−
*[[Idarubicin (Idamycin)]] 12 mg/m2 IV over 1 hour once per day on days 1 to 3
+
*[[Idarubicin (Idamycin)]] 12 mg/m2 IV over 1 hour once daily on days 1 to 3
 
*[[Sorafenib (Nexavar)]] 400 mg PO BID on days 1 to 7
 
*[[Sorafenib (Nexavar)]] 400 mg PO BID on days 1 to 7
  
Line 67: Line 107:
 
==Cytarabine, Idarubicin, Vorinostat==
 
==Cytarabine, Idarubicin, Vorinostat==
 
===Regimen, Garcia-Manero, et al. 2012===
 
===Regimen, Garcia-Manero, et al. 2012===
 +
Level of Evidence:
 +
<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
*[[Vorinostat (Zolinza)]] 500 mg PO TID on days 1 to 3
 
*[[Vorinostat (Zolinza)]] 500 mg PO TID on days 1 to 3
 
*[[Cytarabine (Cytosar)]] 1500 mg/m2/day IV continuous infusion on days 4 to 7
 
*[[Cytarabine (Cytosar)]] 1500 mg/m2/day IV continuous infusion on days 4 to 7
 
**Patients older than 60 received: [[Cytarabine (Cytosar)]] 1500 mg/m2/day IV continuous infusion on days 4 to 6
 
**Patients older than 60 received: [[Cytarabine (Cytosar)]] 1500 mg/m2/day IV continuous infusion on days 4 to 6
−
*[[Idarubicin (Idamycin)]] 12 mg/m2 IV once per day on days 4 to 6
+
*[[Idarubicin (Idamycin)]] 12 mg/m2 IV once daily on days 4 to 6
  
 
'''7-day course x 1 to 2 cycles'''
 
'''7-day course x 1 to 2 cycles'''
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==Decitabine & Valproate==
 
==Decitabine & Valproate==
 
===Regimen, Garcia-Manero, et al. 2006===
 
===Regimen, Garcia-Manero, et al. 2006===
−
*[[Decitabine (Dacogen)]] 15 mg/m2 IV over 1 hour once per day on days 1 to 10
+
Level of Evidence:
 +
<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
 +
*[[Decitabine (Dacogen)]] 15 mg/m2 IV over 1 hour once daily on days 1 to 10
 
*[[Valproate (Depakote)]] 50 mg/kg/day (divided in 2 or 3 doses per day) PO on days 1 to 10
 
*[[Valproate (Depakote)]] 50 mg/kg/day (divided in 2 or 3 doses per day) PO on days 1 to 10
  
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==Idarubicin, Cytarabine, Pravastatin (IAP)==
 
==Idarubicin, Cytarabine, Pravastatin (IAP)==
 
===Regimen, Advani et al. 2013===
 
===Regimen, Advani et al. 2013===
−
*Pravastatin (Pravachol) 1280 mg PO daily, days 1-8
+
Level of Evidence:
−
*[[Idarubicin (Idamycin)]] 12 mg/m2 IV daily, days 4-6
+
<span
−
*[[Cytarabine (Cytosar)]] 1.5 g/m2 IV daily, days 4-7
+
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
 +
*Pravastatin (Pravachol) 1280 mg PO daily, days 1 to 8
 +
*[[Idarubicin (Idamycin)]] 12 mg/m2 IV daily, days 4 to 6
 +
*[[Cytarabine (Cytosar)]] 1.5 g/m2 IV daily, days 4 to 7
  
 
'''Patients achieving a CR could receive 2 cycles of consolidation'''
 
'''Patients achieving a CR could receive 2 cycles of consolidation'''
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==Cytarabine & Daunorubicin==
 
==Cytarabine & Daunorubicin==
 
===Regimen, Gardin, et al. 2007 (ALFA 9803)===
 
===Regimen, Gardin, et al. 2007 (ALFA 9803)===
 +
Level of Evidence:
 +
<span
 +
style="background:#00CD00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase III</span>
 +
 
''Ambulatory regimen''
 
''Ambulatory regimen''
 
*[[Cytarabine (Cytosar)]] 60 mg/m2 SC every 12 hours on days 1 to 5 (10 total doses)
 
*[[Cytarabine (Cytosar)]] 60 mg/m2 SC every 12 hours on days 1 to 5 (10 total doses)
Line 117: Line 189:
 
==Cytarabine, Idarubicin, Sorafenib==
 
==Cytarabine, Idarubicin, Sorafenib==
 
===Regimen, Ravandi, et al. 2010===
 
===Regimen, Ravandi, et al. 2010===
 +
Level of Evidence:
 +
<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
''Preceded by [[#Cytarabine.2C_Idarubicin.2C_Sorafenib|Cytarabine, Idarubicin, Sorafenib induction therapy]].  Regimen details are from the phase II part of the published trial.''
 
''Preceded by [[#Cytarabine.2C_Idarubicin.2C_Sorafenib|Cytarabine, Idarubicin, Sorafenib induction therapy]].  Regimen details are from the phase II part of the published trial.''
 
*[[Cytarabine (Cytosar)]] 750 mg/m2/day IV continuous infusion on days 1 to 3
 
*[[Cytarabine (Cytosar)]] 750 mg/m2/day IV continuous infusion on days 1 to 3
−
*[[Idarubicin (Idamycin)]] 8 mg/m2 IV over 1 hour once per day on days 1 & 2
+
*[[Idarubicin (Idamycin)]] 8 mg/m2 IV over 1 hour once on days 1 & 2
 
*[[Sorafenib (Nexavar)]] 400 mg PO BID "for up to 28 days"
 
*[[Sorafenib (Nexavar)]] 400 mg PO BID "for up to 28 days"
  
Line 129: Line 209:
 
==Cytarabine, Idarubicin, Vorinostat==
 
==Cytarabine, Idarubicin, Vorinostat==
 
===Regimen, Garcia-Manero, et al. 2012===
 
===Regimen, Garcia-Manero, et al. 2012===
 +
Level of Evidence:
 +
<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
''Preceded by [[#Cytarabine_.28Cytosar.29.2C_Idarubicin_.28Idamycin.29.2C_Vorinostat_.28Zolinza.29_induction|Cytarabine (Cytosar), Idarubicin (Idamycin), Vorinostat (Zolinza) induction]] therapy.''
 
''Preceded by [[#Cytarabine_.28Cytosar.29.2C_Idarubicin_.28Idamycin.29.2C_Vorinostat_.28Zolinza.29_induction|Cytarabine (Cytosar), Idarubicin (Idamycin), Vorinostat (Zolinza) induction]] therapy.''
 
*[[Vorinostat (Zolinza)]] 500 mg PO TID on days 1 to 3
 
*[[Vorinostat (Zolinza)]] 500 mg PO TID on days 1 to 3
 
*[[Cytarabine (Cytosar)]] 750 mg/m2/day IV continuous infusion on days 4 to 6
 
*[[Cytarabine (Cytosar)]] 750 mg/m2/day IV continuous infusion on days 4 to 6
−
*[[Idarubicin (Idamycin)]] 8 mg/m2 IV once per day on days 4 to 5
+
*[[Idarubicin (Idamycin)]] 8 mg/m2 IV once on days 4 & 5
  
 
'''6-day course x up to 5 cycles'''
 
'''6-day course x up to 5 cycles'''
Line 148: Line 236:
  
 
===Regimen===
 
===Regimen===
 +
Level of Evidence:
 +
<span
 +
style="background:#00CD00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase III</span>
 +
 
*[[Cytarabine (Cytosar)]] 2000 to 3000 mg/m2 IV over 3 hours Q12H on days 1, 3, 5 (6 total doses)
 
*[[Cytarabine (Cytosar)]] 2000 to 3000 mg/m2 IV over 3 hours Q12H on days 1, 3, 5 (6 total doses)
  
Line 160: Line 256:
  
 
===Regimen===
 
===Regimen===
 +
Level of Evidence:
 +
<span
 +
style="background:#00CD00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase III</span>
 +
 
*[[Cytarabine (Cytosar)]] 1000 mg/m2 IV over 1 hour Q12H on days 1 to 5 (10 total doses)
 
*[[Cytarabine (Cytosar)]] 1000 mg/m2 IV over 1 hour Q12H on days 1 to 5 (10 total doses)
  
Line 172: Line 276:
  
 
===Regimen, Grövdal et al. 2010===
 
===Regimen, Grövdal et al. 2010===
 +
Level of Evidence:
 +
<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
''Intended to be used for transformed MDS patients in remission after AML induction therapy''
 
''Intended to be used for transformed MDS patients in remission after AML induction therapy''
  
Line 185: Line 297:
  
 
===Regimen===
 
===Regimen===
 +
Level of Evidence:
 +
<span
 +
style="background:#00CD00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase III</span>
 +
 
*[[Cytarabine (Cytosar)]] 10 mg/m2 SC BID on days 1 to 21
 
*[[Cytarabine (Cytosar)]] 10 mg/m2 SC BID on days 1 to 21
  
Line 194: Line 314:
 
==Sorafenib (Nexavar)==
 
==Sorafenib (Nexavar)==
 
===Regimen, Ravandi, et al. 2010===
 
===Regimen, Ravandi, et al. 2010===
 +
Level of Evidence:
 +
<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
''Preceded by [[#Cytarabine.2C_Idarubicin.2C_Sorafenib_2|Cytarabine, Idarubicin, Sorafenib consolidation therapy]].  Regimen details are from the phase II part of the published trial.''
 
''Preceded by [[#Cytarabine.2C_Idarubicin.2C_Sorafenib_2|Cytarabine, Idarubicin, Sorafenib consolidation therapy]].  Regimen details are from the phase II part of the published trial.''
 
*[[Sorafenib (Nexavar)]] 400 mg PO BID  
 
*[[Sorafenib (Nexavar)]] 400 mg PO BID  
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==Vorinostat (Zolinza)==
 
==Vorinostat (Zolinza)==
 
===Regimen, Garcia-Manero, et al. 2012===
 
===Regimen, Garcia-Manero, et al. 2012===
 +
Level of Evidence:
 +
<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
''Preceded by [[#Cytarabine_.28Cytosar.29.2C_Idarubicin_.28Idamycin.29.2C_Vorinostat_.28Zolinza.29_consolidation|Cytarabine (Cytosar), Idarubicin (Idamycin), Vorinostat (Zolinza) consolidation]] therapy.''
 
''Preceded by [[#Cytarabine_.28Cytosar.29.2C_Idarubicin_.28Idamycin.29.2C_Vorinostat_.28Zolinza.29_consolidation|Cytarabine (Cytosar), Idarubicin (Idamycin), Vorinostat (Zolinza) consolidation]] therapy.''
 
*[[Vorinostat (Zolinza)]] 200 mg PO TID on days 1 to 14
 
*[[Vorinostat (Zolinza)]] 200 mg PO TID on days 1 to 14
Line 217: Line 353:
  
 
===Regimen, Milligan, et al. 2006 (MRC AML-HR)===
 
===Regimen, Milligan, et al. 2006 (MRC AML-HR)===
 +
Level of Evidence:
 +
<span
 +
style="background:#00CD00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase III</span>
 +
 
====Course 1====
 
====Course 1====
 
*[[Cytarabine (Cytosar)]] 100 mg/m2 IV push Q12H on days 1 to 10 (20 total doses)
 
*[[Cytarabine (Cytosar)]] 100 mg/m2 IV push Q12H on days 1 to 10 (20 total doses)
−
*[[Daunorubicin (Cerubidine)]] 50 mg/m2 IV slow push once per day on days 1, 3, 5
+
*[[Daunorubicin (Cerubidine)]] 50 mg/m2 IV slow push once on days 1, 3, 5
−
*[[Etoposide (Vepesid)]] 100 mg/m2 IV over 1 hour once per day on days 1 to 5  
+
*[[Etoposide (Vepesid)]] 100 mg/m2 IV over 1 hour once daily on days 1 to 5  
  
 
====Course 2====
 
====Course 2====
 
*[[Cytarabine (Cytosar)]] 100 mg/m2 IV push Q12H on days 1 to 8 (16 total doses)
 
*[[Cytarabine (Cytosar)]] 100 mg/m2 IV push Q12H on days 1 to 8 (16 total doses)
−
*[[Daunorubicin (Cerubidine)]] 50 mg/m2 IV slow push once per day on days 1, 3, 5
+
*[[Daunorubicin (Cerubidine)]] 50 mg/m2 IV slow push once on days 1, 3, 5
−
*[[Etoposide (Vepesid)]] 100 mg/m2 IV over 1 hour once per day on days 1 to 5
+
*[[Etoposide (Vepesid)]] 100 mg/m2 IV over 1 hour once daily on days 1 to 5
  
 
===References===
 
===References===
Line 232: Line 376:
 
==Azacitidine (Vidaza)==
 
==Azacitidine (Vidaza)==
 
===Regimen, Thepot, et al. 2010===
 
===Regimen, Thepot, et al. 2010===
−
*[[Azacitidine (Vidaza)]] 75 mg/m2 SC once per day on days 1 to 7
+
Level of Evidence:
 +
<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
 +
*[[Azacitidine (Vidaza)]] 75 mg/m2 SC once daily on days 1 to 7
  
 
'''28-day cycles x at least 4 to 6 cycles'''
 
'''28-day cycles x at least 4 to 6 cycles'''
Line 242: Line 394:
  
 
===Regimen===
 
===Regimen===
 +
Level of Evidence:
 +
<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
''Majority of patients in the phase II trial were FLT-3 ITD positive''
 
''Majority of patients in the phase II trial were FLT-3 ITD positive''
  
−
*[[Azacitidine (Vidaza)]] 75 mg/m2 SC or IV once per day on days 1 to 7
+
*[[Azacitidine (Vidaza)]] 75 mg/m2 SC or IV once daily on days 1 to 7
 
*[[Sorafenib (Nexavar)]] 400 mg PO BID
 
*[[Sorafenib (Nexavar)]] 400 mg PO BID
  
Line 257: Line 417:
 
==Cladribine (Leustatin)==
 
==Cladribine (Leustatin)==
 
===Regimen, Santana, et al. 1992===
 
===Regimen, Santana, et al. 1992===
 +
Level of Evidence:
 +
<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
*[[Cladribine (Leustatin)]] 8.9 mg/m2/day IV continuous infusion on days 1 to 5
 
*[[Cladribine (Leustatin)]] 8.9 mg/m2/day IV continuous infusion on days 1 to 5
  
Line 266: Line 434:
  
 
===Regimen===
 
===Regimen===
−
*[[Cladribine (Leustatin)]] 5 mg/m2 IV over 2 hours once per day on days 1 to 5, given first
+
Level of Evidence:
−
*[[Cytarabine (Cytosar)]] 2000 mg/m2 IV over 4 hours once per day on days 1 to 5, given second, 2 hours after cladribine
+
<span
−
*[[Filgrastim (Neupogen)]] 300 mcg SC once per day on days -1 to 5; first dose is given 24 hours before first dose of cladribine
+
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
 +
*[[Cladribine (Leustatin)]] 5 mg/m2 IV over 2 hours once daily on days 1 to 5, given first
 +
*[[Cytarabine (Cytosar)]] 2000 mg/m2 IV over 4 hours once daily on days 1 to 5, given second, 2 hours after cladribine
 +
*[[Filgrastim (Neupogen)]] 300 mcg SC once daily on days -1 to 5; first dose is given 24 hours before first dose of cladribine
  
 
===References===
 
===References===
 
# Robak T, Wrzesien'-Kus' A, Lech-Maran'da E, Kowal M, Dmoszyn'ska A. Combination regimen of cladribine (2-chlorodeoxyadenosine), cytarabine and G-CSF (CLAG) as induction therapy for patients with relapsed or refractory acute myeloid leukemia. Leuk Lymphoma. 2000 Sep;39(1-2):121-9. [http://informahealthcare.com/doi/abs/10.3109/10428190009053545 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/10975390 PubMed]
 
# Robak T, Wrzesien'-Kus' A, Lech-Maran'da E, Kowal M, Dmoszyn'ska A. Combination regimen of cladribine (2-chlorodeoxyadenosine), cytarabine and G-CSF (CLAG) as induction therapy for patients with relapsed or refractory acute myeloid leukemia. Leuk Lymphoma. 2000 Sep;39(1-2):121-9. [http://informahealthcare.com/doi/abs/10.3109/10428190009053545 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/10975390 PubMed]
−
# Martin MG, Welch JS, Augustin K, Hladnik L, DiPersio JF, Abboud CN. Cladribine in the treatment of acute myeloid leukemia: a single-institution experience. Clin Lymphoma Myeloma. 2009 Aug;9(4):298-301. [http://www.ncbi.nlm.nih.gov/pubmed/19717379 PubMed]
+
# '''Retrospective:''' Martin MG, Welch JS, Augustin K, Hladnik L, DiPersio JF, Abboud CN. Cladribine in the treatment of acute myeloid leukemia: a single-institution experience. Clin Lymphoma Myeloma. 2009 Aug;9(4):298-301. [http://www.ncbi.nlm.nih.gov/pubmed/19717379 PubMed]
  
 
==CLAG-M, CLAM==
 
==CLAG-M, CLAM==
Line 278: Line 454:
  
 
===Regimen===
 
===Regimen===
−
*[[Cladribine (Leustatin)]] 5 mg/m2 IV over 2 hours once per day on days 1 to 5, given first
+
Level of Evidence:
−
*[[Cytarabine (Cytosar)]] 2000 mg/m2 IV over 4 hours once per day on days 1 to 5, given second, 2 hours after cladribine
+
<span
−
*[[Mitoxantrone (Novantrone)]] 10 mg/m2 IV once per day on days 1 to 3
+
style="background:#EEEE00;
−
*[[Filgrastim (Neupogen)]] 300 mcg SC once per day on days -1 to 5; first dose is given 24 hours before first dose of cladribine
+
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
 +
*[[Cladribine (Leustatin)]] 5 mg/m2 IV over 2 hours once daily on days 1 to 5, given first
 +
*[[Cytarabine (Cytosar)]] 2000 mg/m2 IV over 4 hours once daily on days 1 to 5, given second, 2 hours after cladribine
 +
*[[Mitoxantrone (Novantrone)]] 10 mg/m2 IV once daily on days 1 to 3
 +
*[[Filgrastim (Neupogen)]] 300 mcg SC once daily on days -1 to 5; first dose is given 24 hours before first dose of cladribine
  
 
===References===
 
===References===
 
# Wierzbowska A, Robak T, Pluta A, Wawrzyniak E, Cebula B, Hołowiecki J, Kyrcz-Krzemień S, Grosicki S, Giebel S, Skotnicki AB, Piatkowska-Jakubas B, Kuliczkowski K, Kiełbiński M, Zawilska K, Kłoczko J, Wrzesień-Kuś A; Polish Adult Leukemia Group. Cladribine combined with high doses of arabinoside cytosine, mitoxantrone, and G-CSF (CLAG-M) is a highly effective salvage regimen in patients with refractory and relapsed acute myeloid leukemia of the poor risk: a final report of the Polish Adult Leukemia Group. Eur J Haematol. 2008 Feb;80(2):115-26. Epub 2007 Dec 11. [http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0609.2007.00988.x/abstract link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/18076637 PubMed] content property of [http://hemonc.org HemOnc.org]
 
# Wierzbowska A, Robak T, Pluta A, Wawrzyniak E, Cebula B, Hołowiecki J, Kyrcz-Krzemień S, Grosicki S, Giebel S, Skotnicki AB, Piatkowska-Jakubas B, Kuliczkowski K, Kiełbiński M, Zawilska K, Kłoczko J, Wrzesień-Kuś A; Polish Adult Leukemia Group. Cladribine combined with high doses of arabinoside cytosine, mitoxantrone, and G-CSF (CLAG-M) is a highly effective salvage regimen in patients with refractory and relapsed acute myeloid leukemia of the poor risk: a final report of the Polish Adult Leukemia Group. Eur J Haematol. 2008 Feb;80(2):115-26. Epub 2007 Dec 11. [http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0609.2007.00988.x/abstract link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/18076637 PubMed] content property of [http://hemonc.org HemOnc.org]
−
# Martin MG, Welch JS, Augustin K, Hladnik L, DiPersio JF, Abboud CN. Cladribine in the treatment of acute myeloid leukemia: a single-institution experience. Clin Lymphoma Myeloma. 2009 Aug;9(4):298-301. [http://www.ncbi.nlm.nih.gov/pubmed/19717379 PubMed]
+
# '''Retrospective:''' Martin MG, Welch JS, Augustin K, Hladnik L, DiPersio JF, Abboud CN. Cladribine in the treatment of acute myeloid leukemia: a single-institution experience. Clin Lymphoma Myeloma. 2009 Aug;9(4):298-301. [http://www.ncbi.nlm.nih.gov/pubmed/19717379 PubMed]
  
 
==Clofarabine & Cytarabine==
 
==Clofarabine & Cytarabine==
  
 
===Regimen #1, Agura, et al., 2011===
 
===Regimen #1, Agura, et al., 2011===
−
*[[Clofarabine (Clolar)]] 40 mg/m2 IV over 1 hour once per day on days 1 to 5, given first
+
Level of Evidence:
−
*[[Cytarabine (Cytosar)]] 1000 mg/m2 IV over 2 hours once per day on days 1 to 5, given second, 4 hours after completion of clofarabine infusion
+
<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
 +
*[[Clofarabine (Clolar)]] 40 mg/m2 IV over 1 hour once daily on days 1 to 5, given first
 +
*[[Cytarabine (Cytosar)]] 1000 mg/m2 IV over 2 hours once daily on days 1 to 5, given second, 4 hours after completion of clofarabine infusion
  
 
'''up to 4 total cycles;''' subsequent cycles start after hematologic recovery from the previous cycle and were recommended for patients who had hematologic response, but not complete response (CR)
 
'''up to 4 total cycles;''' subsequent cycles start after hematologic recovery from the previous cycle and were recommended for patients who had hematologic response, but not complete response (CR)
  
 
Supportive medications:
 
Supportive medications:
−
*[[Dexamethasone (Decadron)]] 10 mg IV once per day
+
*[[Dexamethasone (Decadron)]] 10 mg IV once daily
 
*[[Antiemesis|5-HT3 antagonists]] on each day of chemotherapy
 
*[[Antiemesis|5-HT3 antagonists]] on each day of chemotherapy
 
*Hydration at 150 mL/m2/H "to prevent tumor lysis syndrome" during chemotherapy
 
*Hydration at 150 mL/m2/H "to prevent tumor lysis syndrome" during chemotherapy
−
*Bumetanide (Bumex) 2 to 4 mg IV push once to twice per day as needed to keep weight within 1 kg of patient's initial weight
+
*Bumetanide (Bumex) 2 to 4 mg IV push once to twice daily as needed to keep weight within 1 kg of patient's initial weight
−
*Levofloxacin (Levaquin) 500 mg PO/IV once per day
+
*Levofloxacin (Levaquin) 500 mg PO/IV once daily
 
*[[Acyclovir (Zovirax)]] 500 mg IV Q12H
 
*[[Acyclovir (Zovirax)]] 500 mg IV Q12H
 
*One of the following antifungals:
 
*One of the following antifungals:
−
**Caspofungin (Cancidas) 50 mg IV once per day
+
**Caspofungin (Cancidas) 50 mg IV once daily
 
**Voriconazole (VFEND) 200 mg (route not specified) BID
 
**Voriconazole (VFEND) 200 mg (route not specified) BID
 
*Parenteral nutrition allowed
 
*Parenteral nutrition allowed
Line 309: Line 501:
  
 
===Regimen #2, Faderl, et al., 2012 (CLASSIC I)===
 
===Regimen #2, Faderl, et al., 2012 (CLASSIC I)===
−
*[[Clofarabine (Clolar)]] 40 mg/m2 IV over 1 hour once per day on days 1 to 5, given first
+
Level of Evidence:
−
*[[Cytarabine (Cytosar)]] 1000 mg/m2 IV over 2 hours once per day on days 1 to 5, given second, 3 hours after completion of clofarabine infusion
+
<span
 +
style="background:#00CD00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase III</span>
 +
 
 +
*[[Clofarabine (Clolar)]] 40 mg/m2 IV over 1 hour once daily on days 1 to 5, given first
 +
*[[Cytarabine (Cytosar)]] 1000 mg/m2 IV over 2 hours once daily on days 1 to 5, given second, 3 hours after completion of clofarabine infusion
  
 
'''1 to 3 cycles;''' It was not clear if the consolidation cycle mentioned here would also be clofarabine and cytarabine or something else: "Patients who achieved remission after their induction cycle could receive a single (optional) consolidation cycle; patients who did not achieve remission after induction but who demonstrated hematologic improvement could receive a reinduction cycle followed by a single (optional) consolidation cycle."
 
'''1 to 3 cycles;''' It was not clear if the consolidation cycle mentioned here would also be clofarabine and cytarabine or something else: "Patients who achieved remission after their induction cycle could receive a single (optional) consolidation cycle; patients who did not achieve remission after induction but who demonstrated hematologic improvement could receive a reinduction cycle followed by a single (optional) consolidation cycle."
Line 324: Line 524:
  
 
===Regimen, Faderl, et al., 2012 (CLASSIC I)===
 
===Regimen, Faderl, et al., 2012 (CLASSIC I)===
−
*[[Cytarabine (Cytosar)]] 1000 mg/m2 IV over 2 hours once per day on days 1 to 5
+
Level of Evidence:
 +
<span
 +
style="background:#00CD00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase III</span>
 +
 
 +
*[[Cytarabine (Cytosar)]] 1000 mg/m2 IV over 2 hours once daily on days 1 to 5
  
 
'''1 to 3 cycles;''' It was not clear if the consolidation cycle mentioned here would also be cytarabine or something else: "Patients who achieved remission after their induction cycle could receive a single (optional) consolidation cycle; patients who did not achieve remission after induction but who demonstrated hematologic improvement could receive a reinduction cycle followed by a single (optional) consolidation cycle."
 
'''1 to 3 cycles;''' It was not clear if the consolidation cycle mentioned here would also be cytarabine or something else: "Patients who achieved remission after their induction cycle could receive a single (optional) consolidation cycle; patients who did not achieve remission after induction but who demonstrated hematologic improvement could receive a reinduction cycle followed by a single (optional) consolidation cycle."
Line 336: Line 544:
 
==Decitabine (Dacogen)==
 
==Decitabine (Dacogen)==
 
===Regimen, Kantarjian, et al. 2012===
 
===Regimen, Kantarjian, et al. 2012===
−
*[[Decitabine (Dacogen)]] 20 mg/m2 IV over 1 hour once per day on days 1 to 5
+
Level of Evidence:
 +
<span
 +
style="background:#00CD00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase III</span>
 +
 
 +
*[[Decitabine (Dacogen)]] 20 mg/m2 IV over 1 hour once daily on days 1 to 5
  
 
'''28-day cycles, given until progression of disease or unacceptable toxicity'''
 
'''28-day cycles, given until progression of disease or unacceptable toxicity'''
Line 350: Line 566:
  
 
===Regimen, Montillo, et al. 1998===
 
===Regimen, Montillo, et al. 1998===
−
*[[Fludarabine (Fludara)]] 30 mg/m2 IV over 30 minutes once per day on days 1 to 5, given first
+
Level of Evidence:
−
*[[Cytarabine (Cytosar)]] 2000 mg/m2 IV over 4 hours once per day on days 1 to 5, given second, 4 hours after the start of fludarabine
+
<span
−
*[[Filgrastim (Neupogen)]] or Lenograstim (Granocyte) 5 mcg/kg SC once per day starting on day -1 (the paper described this as "day 0"), first dose given 24 hours before first dose of chemotherapy, to continue until neutrophil recovery
+
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
 +
*[[Fludarabine (Fludara)]] 30 mg/m2 IV over 30 minutes once daily on days 1 to 5, given first
 +
*[[Cytarabine (Cytosar)]] 2000 mg/m2 IV over 4 hours once daily on days 1 to 5, given second, 4 hours after the start of fludarabine
 +
*[[Filgrastim (Neupogen)]] or Lenograstim (Granocyte) 5 mcg/kg SC once daily starting on day -1 (the paper described this as "day 0"), first dose given 24 hours before first dose of chemotherapy, to continue until neutrophil recovery
  
 
===References===
 
===References===
Line 360: Line 584:
 
FLAG-IDA: '''<u>FL</u>'''udarabine, '''<u>A</u>'''ra-C, '''<u>G</u>'''-CSF, '''<u>IDA</u>'''rubicin
 
FLAG-IDA: '''<u>FL</u>'''udarabine, '''<u>A</u>'''ra-C, '''<u>G</u>'''-CSF, '''<u>IDA</u>'''rubicin
 
===Regimen===
 
===Regimen===
−
*[[Fludarabine (Fludara)]] 30 mg/m2 IV over 30 minutes once per day on days 1 to 5, given first
+
Level of Evidence:
−
*[[Cytarabine (Cytosar)]] 2000 mg/m2 IV over 4 hours once per day on days 1 to 5, given second, 4 hours after fludarabine
+
<span
−
*[[Idarubicin (Idamycin)]] 10 mg/m2 IV once per day on days 1 to 3
+
style="background:#EEEE00;
−
*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day starting on day 6, to continue until neutrophil recovery
+
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
 +
*[[Fludarabine (Fludara)]] 30 mg/m2 IV over 30 minutes once daily on days 1 to 5, given first
 +
*[[Cytarabine (Cytosar)]] 2000 mg/m2 IV over 4 hours once daily on days 1 to 5, given second, 4 hours after fludarabine
 +
*[[Idarubicin (Idamycin)]] 10 mg/m2 IV once daily on days 1 to 3
 +
*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once daily starting on day 6, to continue until neutrophil recovery
  
 
===References===
 
===References===
Line 371: Line 603:
 
==Mitoxantrone & Cytarabine==
 
==Mitoxantrone & Cytarabine==
 
===Regimen, Sternberg, et al. 2000===
 
===Regimen, Sternberg, et al. 2000===
−
*[[Mitoxantrone (Novantrone)]] 5 mg/m2 IV bolus once per day on days 1 to 5
+
Level of Evidence:
 +
<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
 +
*[[Mitoxantrone (Novantrone)]] 5 mg/m2 IV bolus once daily on days 1 to 5
 
*[[Cytarabine (Cytosar)]] 500 mg/m2 IV over 90 minutes every 12 hours on days 1 to 6 (12 total doses)
 
*[[Cytarabine (Cytosar)]] 500 mg/m2 IV over 90 minutes every 12 hours on days 1 to 6 (12 total doses)
  
Line 379: Line 619:
 
==Mitoxantrone & Etoposide==
 
==Mitoxantrone & Etoposide==
 
===Regimen, Ho, et al. 1988===
 
===Regimen, Ho, et al. 1988===
−
*[[Mitoxantrone (Novantrone)]] 10 mg/m2 IV over 15 minutes once per day on days 1 to 5
+
Level of Evidence:
−
*[[Etoposide (Vepesid)]] 100 mg/m2 IV over 30 minutes once per day on days 1 to 5
+
<span
 +
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
 +
*[[Mitoxantrone (Novantrone)]] 10 mg/m2 IV over 15 minutes once daily on days 1 to 5
 +
*[[Etoposide (Vepesid)]] 100 mg/m2 IV over 30 minutes once daily on days 1 to 5
  
 
===References===
 
===References===
Line 388: Line 636:
 
MEC: '''<u>M</u>'''itoxantrone, '''<u>E</u>'''toposide, '''<u>C</u>'''ytarabine
 
MEC: '''<u>M</u>'''itoxantrone, '''<u>E</u>'''toposide, '''<u>C</u>'''ytarabine
 
===Regimen #1, Amadori, et al. 1991===
 
===Regimen #1, Amadori, et al. 1991===
−
*[[Mitoxantrone (Novantrone)]] 6 mg/m2 IV bolus once per day on days 1 to 6
+
Level of Evidence:
−
*[[Etoposide (Vepesid)]] 80 mg/m2 IV over 1 hour once per day on days 1 to 6
+
<span
−
*[[Cytarabine (Cytosar)]] 1000 mg/m2 IV over 6 hours once per day on days 1 to 6
+
style="background:#EEEE00;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Phase II</span>
 +
 
 +
*[[Mitoxantrone (Novantrone)]] 6 mg/m2 IV bolus once daily on days 1 to 6
 +
*[[Etoposide (Vepesid)]] 80 mg/m2 IV over 1 hour once daily on days 1 to 6
 +
*[[Cytarabine (Cytosar)]] 1000 mg/m2 IV over 6 hours once daily on days 1 to 6
  
 
===Regimen #2, Kohrt, et al. 2010===
 
===Regimen #2, Kohrt, et al. 2010===
−
*[[Mitoxantrone (Novantrone)]] 8 mg/m2 IV push once per day on days 1 to 5, given third
+
Level of Evidence:
−
*[[Etoposide (Vepesid)]] 100 mg/m2 IV over 2 hours once per day on days 1 to 5, given first
+
<span
−
*[[Cytarabine (Cytosar)]] 1000 mg/m2 IV once per day on days 1 to 5, given second
+
style="background:#ff0000;
 +
padding:3px 6px 3px 6px;
 +
border-color:black;
 +
border-width:2px;
 +
border-style:solid;">Retrospective</span>
 +
 
 +
*[[Mitoxantrone (Novantrone)]] 8 mg/m2 IV push once daily on days 1 to 5, given third
 +
*[[Etoposide (Vepesid)]] 100 mg/m2 IV over 2 hours once daily on days 1 to 5, given first
 +
*[[Cytarabine (Cytosar)]] 1000 mg/m2 IV once daily on days 1 to 5, given second
  
 
===References===
 
===References===
 
# Amadori S, Arcese W, Isacchi G, Meloni G, Petti MC, Monarca B, Testi AM, Mandelli F. Mitoxantrone, etoposide, and intermediate-dose cytarabine: an effective and tolerable regimen for the treatment of refractory acute myeloid leukemia. J Clin Oncol. 1991 Jul;9(7):1210-4. [http://jco.ascopubs.org/content/9/7/1210.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/2045861 PubMed]
 
# Amadori S, Arcese W, Isacchi G, Meloni G, Petti MC, Monarca B, Testi AM, Mandelli F. Mitoxantrone, etoposide, and intermediate-dose cytarabine: an effective and tolerable regimen for the treatment of refractory acute myeloid leukemia. J Clin Oncol. 1991 Jul;9(7):1210-4. [http://jco.ascopubs.org/content/9/7/1210.long link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/2045861 PubMed]
 
# Kohrt HE, Patel S, Ho M, Owen T, Pollyea DA, Majeti R, Gotlib J, Coutre S, Liedtke M, Berube C, Alizadeh AA, Medeiros BC. Second-line mitoxantrone, etoposide, and cytarabine for acute myeloid leukemia: a single-center experience. Am J Hematol. 2010 Nov;85(11):877-81. [http://onlinelibrary.wiley.com/doi/10.1002/ajh.21857/full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/20872554 PubMed]
 
# Kohrt HE, Patel S, Ho M, Owen T, Pollyea DA, Majeti R, Gotlib J, Coutre S, Liedtke M, Berube C, Alizadeh AA, Medeiros BC. Second-line mitoxantrone, etoposide, and cytarabine for acute myeloid leukemia: a single-center experience. Am J Hematol. 2010 Nov;85(11):877-81. [http://onlinelibrary.wiley.com/doi/10.1002/ajh.21857/full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/20872554 PubMed]

Revision as of 19:29, 5 July 2013

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Is there a regimen missing from this list? Would you like to share a different dosage/schedule or an additional reference for a regimen? Have you noticed an error? Do you have an idea that will help the site grow to better meet your needs and the needs of many others? You are invited to contribute to the site.


Induction therapy

7+3 Cytarabine & Daunorubicin ("Standard" or "conventional" dose)

Regimen

Level of Evidence: Phase III

7-day course

References

  1. Preisler H, Davis RB, Kirshner J, Dupre E, Richards F 3rd, Hoagland HC, Kopel S, Levy RN, Carey R, Schulman P, et al. Comparison of three remission induction regimens and two postinduction strategies for the treatment of acute nonlymphocytic leukemia: a cancer and leukemia group B study. Blood. 1987 May;69(5):1441-9. link to original article contains verified protocol PubMed
  2. Rowe JM, Neuberg D, Friedenberg W, Bennett JM, Paietta E, Makary AZ, Liesveld JL, Abboud CN, Dewald G, Hayes FA, Tallman MS, Wiernik PH; Eastern Cooperative Oncology. A phase 3 study of three induction regimens and of priming with GM-CSF in older adults with acute myeloid leukemia: a trial by the Eastern Cooperative Oncology Group. Blood. 2004 Jan 15;103(2):479-85. Epub 2003 Sep 25. link to original article contains verified protocol PubMed
  3. Löwenberg B, Ossenkoppele GJ, van Putten W, Schouten HC, Graux C, Ferrant A, Sonneveld P, Maertens J, Jongen-Lavrencic M, von Lilienfeld-Toal M, Biemond BJ, Vellenga E, van Marwijk Kooy M, Verdonck LF, Beck J, Döhner H, Gratwohl A, Pabst T, Verhoef G; Dutch-Belgian Cooperative Trial Group for Hemato-Oncology (HOVON); German AML Study Group (AMLSG); Swiss Group for Clinical Cancer Research (SAKK) Collaborative Group. High-dose daunorubicin in older patients with acute myeloid leukemia. N Engl J Med. 2009 Sep 24;361(13):1235-48. doi: 10.1056/NEJMoa0901409. Erratum in: N Engl J Med. 2010 Mar 25;362(12):1155. Dosage error in published abstract; MEDLINE/PubMed abstract corrected; Dosage error in article text. link to original article contains verified protocol PubMed
  4. Fernandez HF, Sun Z, Yao X, Litzow MR, Luger SM, Paietta EM, Racevskis J, Dewald GW, Ketterling RP, Bennett JM, Rowe JM, Lazarus HM, Tallman MS. Anthracycline dose intensification in acute myeloid leukemia. N Engl J Med. 2009 Sep 24;361(13):1249-59. link to original article contains verified protocol PubMed
  5. Döhner H, Estey EH, Amadori S, Appelbaum FR, Büchner T, Burnett AK, Dombret H, Fenaux P, Grimwade D, Larson RA, Lo-Coco F, Naoe T, Niederwieser D, Ossenkoppele GJ, Sanz MA, Sierra J, Tallman MS, Löwenberg B, Bloomfield CD; European LeukemiaNet. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010 Jan 21;115(3):453-74. Epub 2009 Oct 30. link to original article contains verified protocol PubMed

7+3 Cytarabine & Daunorubicin ("High" or "escalated" dose)

Regimen #1, Fernandez et al. 2009

Level of Evidence: Phase III

7-day course

Regimen #2, Löwenberg et al. 2009 (HOVON/AMLSG/SAKK)

Level of Evidence: Phase III

7-day course

References

  1. Löwenberg B, Ossenkoppele GJ, van Putten W, Schouten HC, Graux C, Ferrant A, Sonneveld P, Maertens J, Jongen-Lavrencic M, von Lilienfeld-Toal M, Biemond BJ, Vellenga E, van Marwijk Kooy M, Verdonck LF, Beck J, Döhner H, Gratwohl A, Pabst T, Verhoef G; Dutch-Belgian Cooperative Trial Group for Hemato-Oncology (HOVON); German AML Study Group (AMLSG); Swiss Group for Clinical Cancer Research (SAKK) Collaborative Group. High-dose daunorubicin in older patients with acute myeloid leukemia. N Engl J Med. 2009 Sep 24;361(13):1235-48. doi: 10.1056/NEJMoa0901409. Erratum in: N Engl J Med. 2010 Mar 25;362(12):1155. Dosage error in published abstract; MEDLINE/PubMed abstract corrected; Dosage error in article text. link to original article contains verified protocol PubMed
  2. Fernandez HF, Sun Z, Yao X, Litzow MR, Luger SM, Paietta EM, Racevskis J, Dewald GW, Ketterling RP, Bennett JM, Rowe JM, Lazarus HM, Tallman MS. Anthracycline dose intensification in acute myeloid leukemia. N Engl J Med. 2009 Sep 24;361(13):1249-59. link to original article contains verified protocol PubMed

7+3 Cytarabine & Idarubicin

Regimen

Level of Evidence: Phase III

7-day course

References

  1. Wiernik PH, Banks PL, Case DC Jr, Arlin ZA, Periman PO, Todd MB, Ritch PS, Enck RE, Weitberg AB. Cytarabine plus idarubicin or daunorubicin as induction and consolidation therapy for previously untreated adult patients with acute myeloid leukemia. Blood. 1992 Jan 15;79(2):313-9. link to original article PubMed
  2. Haas R, Ho AD, Del Valle F, Fischer JT, Ehrhardt R, Döhner H, Witt B, Huberts H, Kaplan E, Hunstein W. Idarubicin/cytosine arabinoside and mitoxantrone/etoposide for the treatment of de novo acute myelogenous leukemia. Semin Oncol. 1993 Dec;20(6 Suppl 8):20-6. PubMed
  3. Masaoka T, Ogawa M, Yamada K, Kimura K, Ohashi Y. A phase II comparative study of idarubicin plus cytarabine versus daunorubicin plus cytarabine in adult acute myeloid leukemia. Semin Hematol. 1996 Oct;33(4 Suppl 3):12-7. PubMed
  4. Rowe JM, Neuberg D, Friedenberg W, Bennett JM, Paietta E, Makary AZ, Liesveld JL, Abboud CN, Dewald G, Hayes FA, Tallman MS, Wiernik PH; Eastern Cooperative Oncology. A phase 3 study of three induction regimens and of priming with GM-CSF in older adults with acute myeloid leukemia: a trial by the Eastern Cooperative Oncology Group. Blood. 2004 Jan 15;103(2):479-85. Epub 2003 Sep 25. link to original article contains verified protocol PubMed
  5. Döhner H, Estey EH, Amadori S, Appelbaum FR, Büchner T, Burnett AK, Dombret H, Fenaux P, Grimwade D, Larson RA, Lo-Coco F, Naoe T, Niederwieser D, Ossenkoppele GJ, Sanz MA, Sierra J, Tallman MS, Löwenberg B, Bloomfield CD; European LeukemiaNet. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010 Jan 21;115(3):453-74. Epub 2009 Oct 30. link to original article contains verified protocol PubMed

Cytarabine, Idarubicin, Sorafenib

Regimen, Ravandi, et al. 2010

Level of Evidence: Phase II

Regimen details are from the phase II part of the published trial.

7-day course, followed by Cytarabine, Idarubicin, Sorafenib consolidation therapy

References

  1. Ravandi F, Cortes JE, Jones D, Faderl S, Garcia-Manero G, Konopleva MY, O'Brien S, Estrov Z, Borthakur G, Thomas D, Pierce SR, Brandt M, Byrd A, Bekele BN, Pratz K, Luthra R, Levis M, Andreeff M, Kantarjian HM. Phase I/II study of combination therapy with sorafenib, idarubicin, and cytarabine in younger patients with acute myeloid leukemia. J Clin Oncol. 2010 Apr 10;28(11):1856-62. doi: 10.1200/JCO.2009.25.4888. Epub 2010 Mar 8. link to original article contains verified protocol PubMed

Cytarabine, Idarubicin, Vorinostat

Regimen, Garcia-Manero, et al. 2012

Level of Evidence: Phase II

7-day course x 1 to 2 cycles

Supportive medications:

  • Methylprednisolone (Solumedrol) (note: the paper spelled this as "salumedrol"--it's assumed this is what they meant) 50 mg IV on days of cytarabine to prevent fever and rash

To be followed by Cytarabine (Cytosar), Idarubicin (Idamycin), Vorinostat (Zolinza) consolidation therapy.

References

  1. Garcia-Manero G, Tambaro FP, Bekele NB, Yang H, Ravandi F, Jabbour E, Borthakur G, Kadia TM, Konopleva MY, Faderl S, Cortes JE, Brandt M, Hu Y, McCue D, Newsome WM, Pierce SR, de Lima M, Kantarjian HM. Phase II Trial of Vorinostat With Idarubicin and Cytarabine for Patients With Newly Diagnosed Acute Myelogenous Leukemia or Myelodysplastic Syndrome. J Clin Oncol. 2012 Jun 20;30(18):2204-10. Epub 2012 May 14. link to original article contains verified protocol PubMed

Decitabine & Valproate

Regimen, Garcia-Manero, et al. 2006

Level of Evidence: Phase II

28-day cycles x up to 24 total cycles

References

  1. Garcia-Manero G, Kantarjian HM, Sanchez-Gonzalez B, Yang H, Rosner G, Verstovsek S, Rytting M, Wierda WG, Ravandi F, Koller C, Xiao L, Faderl S, Estrov Z, Cortes J, O'brien S, Estey E, Bueso-Ramos C, Fiorentino J, Jabbour E, Issa JP. Phase 1/2 study of the combination of 5-aza-2'-deoxycytidine with valproic acid in patients with leukemia. Blood. 2006 Nov 15;108(10):3271-9. Epub 2006 Aug 1. link to original article contains verified protocol PubMed

Idarubicin, Cytarabine, Pravastatin (IAP)

Regimen, Advani et al. 2013

Level of Evidence: Phase II

Patients achieving a CR could receive 2 cycles of consolidation

References

  1. Anjali S. Advani, Shannon McDonough, Edward Copelan, Cheryl L. Willman, Deborah A. Mulford, Alan F. List, Mikkael A. Sekeres, Megan Othus, Harry P. Erba, Frederick R. Appelbaum. SWOG S0919: A phase II study of idarubicin and cytarabine in combination with pravastatin for relapsed acute myeloid leukemia (AML). J Clin Oncol 31, 2013 (suppl; abstr 7028). link to original article contains verified protocol

Consolidation therapy

Cytarabine & Daunorubicin

Regimen, Gardin, et al. 2007 (ALFA 9803)

Level of Evidence: Phase III

Ambulatory regimen

1-month cycles x up to 6 cycles

References

  1. Gardin C, Turlure P, Fagot T, Thomas X, Terre C, Contentin N, Raffoux E, de Botton S, Pautas C, Reman O, Bourhis JH, Fenaux P, Castaigne S, Michallet M, Preudhomme C, de Revel T, Bordessoule D, Dombret H. Postremission treatment of elderly patients with acute myeloid leukemia in first complete remission after intensive induction chemotherapy: results of the multicenter randomized Acute Leukemia French Association (ALFA) 9803 trial. Blood. 2007 Jun 15;109(12):5129-35. Epub 2007 Mar 6. link to original article contains verified protocol PubMed

Cytarabine, Idarubicin, Sorafenib

Regimen, Ravandi, et al. 2010

Level of Evidence: Phase II

Preceded by Cytarabine, Idarubicin, Sorafenib induction therapy. Regimen details are from the phase II part of the published trial.

4 to 6-week cycles x up to 5 cycles, followed by Sorafenib maintenance therapy

References

  1. Ravandi F, Cortes JE, Jones D, Faderl S, Garcia-Manero G, Konopleva MY, O'Brien S, Estrov Z, Borthakur G, Thomas D, Pierce SR, Brandt M, Byrd A, Bekele BN, Pratz K, Luthra R, Levis M, Andreeff M, Kantarjian HM. Phase I/II study of combination therapy with sorafenib, idarubicin, and cytarabine in younger patients with acute myeloid leukemia. J Clin Oncol. 2010 Apr 10;28(11):1856-62. doi: 10.1200/JCO.2009.25.4888. Epub 2010 Mar 8. link to original article contains verified protocol PubMed

Cytarabine, Idarubicin, Vorinostat

Regimen, Garcia-Manero, et al. 2012

Level of Evidence: Phase II

Preceded by Cytarabine (Cytosar), Idarubicin (Idamycin), Vorinostat (Zolinza) induction therapy.

6-day course x up to 5 cycles

Supportive medications:

  • Methylprednisolone (Solu-Medrol) (note: the paper spelled this as "salumedrol"--it's assumed this is what they meant) 50 mg IV on days of cytarabine to prevent fever and rash

To be followed by Vorinostat (Zolinza) maintenance therapy.

References

  1. Garcia-Manero G, Tambaro FP, Bekele NB, Yang H, Ravandi F, Jabbour E, Borthakur G, Kadia TM, Konopleva MY, Faderl S, Cortes JE, Brandt M, Hu Y, McCue D, Newsome WM, Pierce SR, de Lima M, Kantarjian HM. Phase II Trial of Vorinostat With Idarubicin and Cytarabine for Patients With Newly Diagnosed Acute Myelogenous Leukemia or Myelodysplastic Syndrome. J Clin Oncol. 2012 Jun 20;30(18):2204-10. Epub 2012 May 14. link to original article contains verified protocol PubMed

HiDAC/HDAC, high-dose Cytarabine

HiDAC: High Dose Ara-C

Regimen

Level of Evidence: Phase III

28-day (minimum) cycles or 1 week after marrow recovery, whichever comes later, x up to 4 cycles

References

  1. Mayer RJ, Davis RB, Schiffer CA, Berg DT, Powell BL, Schulman P, Omura GA, Moore JO, McIntyre OR, Frei E 3rd. Intensive postremission chemotherapy in adults with acute myeloid leukemia. Cancer and Leukemia Group B. N Engl J Med. 1994 Oct 6;331(14):896-903. link to original article contains verified protocol PubMed
  2. Fukushima T, Urasaki Y, Yamaguchi M, Ueda M, Morinaga K, Haba T, Sugiyama T, Nakao S, Origasa H, Umehara H, Ueda T. A randomized comparison of modified intermediate-dose Ara-C versus high-dose ara-c in post-remission therapy for acute myeloid leukemia. Anticancer Res. 2012 Feb;32(2):643-7. link to original article contains verified protocol PubMed

MiDAC/MDAC, mid-dose Cytarabine

MiDAC: Mid Dose Ara-C

Regimen

Level of Evidence: Phase III

subsequent cycles started after marrow recovery

References

  1. Fukushima T, Urasaki Y, Yamaguchi M, Ueda M, Morinaga K, Haba T, Sugiyama T, Nakao S, Origasa H, Umehara H, Ueda T. A randomized comparison of modified intermediate-dose Ara-C versus high-dose ara-c in post-remission therapy for acute myeloid leukemia. Anticancer Res. 2012 Feb;32(2):643-7. link to original article contains verified protocol PubMed

Maintenance therapy

Azacitidine (Vidaza)

Regimen, Grövdal et al. 2010

Level of Evidence: Phase II

Intended to be used for transformed MDS patients in remission after AML induction therapy

28-day cycles

References

  1. Grövdal M, Karimi M, Khan R, Aggerholm A, Antunovic P, Astermark J, Bernell P, Engström LM, Kjeldsen L, Linder O, Nilsson L, Olsson A, Holm MS, Tangen JM, Wallvik J, Oberg G, Hokland P, Jacobsen SE, Porwit A, Hellström-Lindberg E. Maintenance treatment with azacytidine for patients with high-risk myelodysplastic syndromes (MDS) or acute myeloid leukaemia following MDS in complete remission after induction chemotherapy. Br J Haematol. 2010 Aug;150(3):293-302. doi: 10.1111/j.1365-2141.2010.08235.x. Epub 2010 May 20. link to original article contains verified protocol PubMed

LDAC

LDAC: Low Dose Ara-C (cytarabine)

Regimen

Level of Evidence: Phase III

2-month cycles, continue until relapse

References

  1. Robles C, Kim KM, Oken MM, Bennett JM, Letendre L, Wiernik PH, O'Connell MJ, Cassileth PA. Low-dose cytarabine maintenance therapy vs observation after remission induction in advanced acute myeloid leukemia: an Eastern Cooperative Oncology Group Trial (E5483). Leukemia. 2000 Aug;14(8):1349-53. contains protocol PubMed

Sorafenib (Nexavar)

Regimen, Ravandi, et al. 2010

Level of Evidence: Phase II

Preceded by Cytarabine, Idarubicin, Sorafenib consolidation therapy. Regimen details are from the phase II part of the published trial.

Up to one year of sorafenib therapy, including consolidation course(s)

References

  1. Ravandi F, Cortes JE, Jones D, Faderl S, Garcia-Manero G, Konopleva MY, O'Brien S, Estrov Z, Borthakur G, Thomas D, Pierce SR, Brandt M, Byrd A, Bekele BN, Pratz K, Luthra R, Levis M, Andreeff M, Kantarjian HM. Phase I/II study of combination therapy with sorafenib, idarubicin, and cytarabine in younger patients with acute myeloid leukemia. J Clin Oncol. 2010 Apr 10;28(11):1856-62. doi: 10.1200/JCO.2009.25.4888. Epub 2010 Mar 8. link to original article contains verified protocol PubMed

Vorinostat (Zolinza)

Regimen, Garcia-Manero, et al. 2012

Level of Evidence: Phase II

Preceded by Cytarabine (Cytosar), Idarubicin (Idamycin), Vorinostat (Zolinza) consolidation therapy.

28-day cycles x up to 12 cycles

References

  1. Garcia-Manero G, Tambaro FP, Bekele NB, Yang H, Ravandi F, Jabbour E, Borthakur G, Kadia TM, Konopleva MY, Faderl S, Cortes JE, Brandt M, Hu Y, McCue D, Newsome WM, Pierce SR, de Lima M, Kantarjian HM. Phase II Trial of Vorinostat With Idarubicin and Cytarabine for Patients With Newly Diagnosed Acute Myelogenous Leukemia or Myelodysplastic Syndrome. J Clin Oncol. 2012 Jun 20;30(18):2204-10. Epub 2012 May 14. link to original article contains verified protocol PubMed

Relapsed/refractory

ADE

ADE: Ara-C, Daunorubicin, Etoposide

Regimen, Milligan, et al. 2006 (MRC AML-HR)

Level of Evidence: Phase III

Course 1

Course 2

References

  1. Milligan DW, Wheatley K, Littlewood T, Craig JI, Burnett AK; NCRI Haematological Oncology Clinical Studies Group. Fludarabine and cytosine are less effective than standard ADE chemotherapy in high-risk acute myeloid leukemia, and addition of G-CSF and ATRA are not beneficial: results of the MRC AML-HR randomized trial. Blood. 2006 Jun 15;107(12):4614-22. Epub 2006 Feb 16. link to original article PubMed

Azacitidine (Vidaza)

Regimen, Thepot, et al. 2010

Level of Evidence: Phase II

28-day cycles x at least 4 to 6 cycles

References

  1. Thepot S, Itzykson R, Seegers V, Raffoux E, Quesnel B, Chait Y, Sorin L, Dreyfus F, Cluzeau T, Delaunay J, Sanhes L, Eclache V, Dartigeas C, Turlure P, Harel S, Salanoubat C, Kiladjian JJ, Fenaux P, Adès L; Groupe Francophone des Myelodysplasies (GFM). Treatment of progression of Philadelphia-negative myeloproliferative neoplasms to myelodysplastic syndrome or acute myeloid leukemia by azacitidine: a report on 54 cases on the behalf of the Groupe Francophone des Myelodysplasies (GFM). Blood. 2010 Nov 11;116(19):3735-42. Epub 2010 Jul 27. link to original article PubMed

Azacitidine & Sorafenib

Regimen

Level of Evidence: Phase II

Majority of patients in the phase II trial were FLT-3 ITD positive

4 to 8 week cycles at treating physician's discretion

Supportive medications:

  • "All patients received antimicrobials, supportive care, and transfusions of blood products according to the institutional guidelines."

References

  1. Ravandi F, Alattar ML, Grunwald MR, Rudek MA, Rajkhowa T, Richie MA, Pierce S, Daver N, Garcia-Manero G, Faderl S, Nazha A, Konopleva M, Borthakur G, Burger J, Kadia T, Dellasala S, Andreeff M, Cortes J, Kantarjian H, Levis M. Phase 2 study of azacytidine plus sorafenib in patients with acute myeloid leukemia and FLT-3 internal tandem duplication mutation. Blood. 2013 Jun 6;121(23):4655-62. doi:10.1182/blood-2013-01-480228. Epub 2013 Apr 23. link to original article contains verified protocol PubMed

Cladribine (Leustatin)

Regimen, Santana, et al. 1992

Level of Evidence: Phase II

References

  1. Santana VM, Mirro J Jr, Kearns C, Schell MJ, Crom W, Blakley RL. 2-Chlorodeoxyadenosine produces a high rate of complete hematologic remission in relapsed acute myeloid leukemia. J Clin Oncol. 1992 Mar;10(3):364-70. link to original article PubMed

CLAG

CLAG: CLadribine, Ara-C, G-CSF

Regimen

Level of Evidence: Phase II

  • Cladribine (Leustatin) 5 mg/m2 IV over 2 hours once daily on days 1 to 5, given first
  • Cytarabine (Cytosar) 2000 mg/m2 IV over 4 hours once daily on days 1 to 5, given second, 2 hours after cladribine
  • Filgrastim (Neupogen) 300 mcg SC once daily on days -1 to 5; first dose is given 24 hours before first dose of cladribine

References

  1. Robak T, Wrzesien'-Kus' A, Lech-Maran'da E, Kowal M, Dmoszyn'ska A. Combination regimen of cladribine (2-chlorodeoxyadenosine), cytarabine and G-CSF (CLAG) as induction therapy for patients with relapsed or refractory acute myeloid leukemia. Leuk Lymphoma. 2000 Sep;39(1-2):121-9. link to original article contains verified protocol PubMed
  2. Retrospective: Martin MG, Welch JS, Augustin K, Hladnik L, DiPersio JF, Abboud CN. Cladribine in the treatment of acute myeloid leukemia: a single-institution experience. Clin Lymphoma Myeloma. 2009 Aug;9(4):298-301. PubMed

CLAG-M, CLAM

CLAG-M: CLadribine, Ara-C, G-CSF, Mitoxantrone

Regimen

Level of Evidence: Phase II

References

  1. Wierzbowska A, Robak T, Pluta A, Wawrzyniak E, Cebula B, Hołowiecki J, Kyrcz-Krzemień S, Grosicki S, Giebel S, Skotnicki AB, Piatkowska-Jakubas B, Kuliczkowski K, Kiełbiński M, Zawilska K, Kłoczko J, Wrzesień-Kuś A; Polish Adult Leukemia Group. Cladribine combined with high doses of arabinoside cytosine, mitoxantrone, and G-CSF (CLAG-M) is a highly effective salvage regimen in patients with refractory and relapsed acute myeloid leukemia of the poor risk: a final report of the Polish Adult Leukemia Group. Eur J Haematol. 2008 Feb;80(2):115-26. Epub 2007 Dec 11. link to original article PubMed content property of HemOnc.org
  2. Retrospective: Martin MG, Welch JS, Augustin K, Hladnik L, DiPersio JF, Abboud CN. Cladribine in the treatment of acute myeloid leukemia: a single-institution experience. Clin Lymphoma Myeloma. 2009 Aug;9(4):298-301. PubMed

Clofarabine & Cytarabine

Regimen #1, Agura, et al., 2011

Level of Evidence: Phase II

  • Clofarabine (Clolar) 40 mg/m2 IV over 1 hour once daily on days 1 to 5, given first
  • Cytarabine (Cytosar) 1000 mg/m2 IV over 2 hours once daily on days 1 to 5, given second, 4 hours after completion of clofarabine infusion

up to 4 total cycles; subsequent cycles start after hematologic recovery from the previous cycle and were recommended for patients who had hematologic response, but not complete response (CR)

Supportive medications:

  • Dexamethasone (Decadron) 10 mg IV once daily
  • 5-HT3 antagonists on each day of chemotherapy
  • Hydration at 150 mL/m2/H "to prevent tumor lysis syndrome" during chemotherapy
  • Bumetanide (Bumex) 2 to 4 mg IV push once to twice daily as needed to keep weight within 1 kg of patient's initial weight
  • Levofloxacin (Levaquin) 500 mg PO/IV once daily
  • Acyclovir (Zovirax) 500 mg IV Q12H
  • One of the following antifungals:
    • Caspofungin (Cancidas) 50 mg IV once daily
    • Voriconazole (VFEND) 200 mg (route not specified) BID
  • Parenteral nutrition allowed
  • No routine use of growth factors

Regimen #2, Faderl, et al., 2012 (CLASSIC I)

Level of Evidence: Phase III

  • Clofarabine (Clolar) 40 mg/m2 IV over 1 hour once daily on days 1 to 5, given first
  • Cytarabine (Cytosar) 1000 mg/m2 IV over 2 hours once daily on days 1 to 5, given second, 3 hours after completion of clofarabine infusion

1 to 3 cycles; It was not clear if the consolidation cycle mentioned here would also be clofarabine and cytarabine or something else: "Patients who achieved remission after their induction cycle could receive a single (optional) consolidation cycle; patients who did not achieve remission after induction but who demonstrated hematologic improvement could receive a reinduction cycle followed by a single (optional) consolidation cycle."

Supportive medications:

  • "The use of prophylactic antibacterial, antifungal, and antiviral agents was recommended according to institutional guidelines."

References

  1. Agura E, Cooper B, Holmes H, Vance E, Berryman RB, Maisel C, Li S, Saracino G, Tadic-Ovcina M, Fay J. Report of a phase II study of clofarabine and cytarabine in de novo and relapsed and refractory AML patients and in selected elderly patients at high risk for anthracycline toxicity. Oncologist. 2011;16(2):197-206. doi: 10.1634/theoncologist.2010-0220. Epub 2011 Jan 27. link to original article contains verified protocol PubMed
  2. Faderl S, Wetzler M, Rizzieri D, Schiller G, Jagasia M, Stuart R, Ganguly S, Avigan D, Craig M, Collins R, Maris M, Kovacsovics T, Goldberg S, Seiter K, Hari P, Greiner J, Vey N, Recher C, Ravandi F, Wang ES, Vasconcelles M, Huebner D, Kantarjian HM. Clofarabine plus cytarabine compared with cytarabine alone in older patients with relapsed or refractory acute myelogenous leukemia: results from the CLASSIC I Trial. J Clin Oncol. 2012 Jul 10;30(20):2492-9. doi:10.1200/JCO.2011.37.9743. Epub 2012 May 14. link to original article contains verified protocol PubMed

Cytarabine (Cytosar)

Regimen, Faderl, et al., 2012 (CLASSIC I)

Level of Evidence: Phase III

1 to 3 cycles; It was not clear if the consolidation cycle mentioned here would also be cytarabine or something else: "Patients who achieved remission after their induction cycle could receive a single (optional) consolidation cycle; patients who did not achieve remission after induction but who demonstrated hematologic improvement could receive a reinduction cycle followed by a single (optional) consolidation cycle."

Supportive medications:

  • "The use of prophylactic antibacterial, antifungal, and antiviral agents was recommended according to institutional guidelines."

References

  1. Faderl S, Wetzler M, Rizzieri D, Schiller G, Jagasia M, Stuart R, Ganguly S, Avigan D, Craig M, Collins R, Maris M, Kovacsovics T, Goldberg S, Seiter K, Hari P, Greiner J, Vey N, Recher C, Ravandi F, Wang ES, Vasconcelles M, Huebner D, Kantarjian HM. Clofarabine plus cytarabine compared with cytarabine alone in older patients with relapsed or refractory acute myelogenous leukemia: results from the CLASSIC I Trial. J Clin Oncol. 2012 Jul 10;30(20):2492-9. doi:10.1200/JCO.2011.37.9743. Epub 2012 May 14. link to original article contains verified protocol PubMed

Decitabine (Dacogen)

Regimen, Kantarjian, et al. 2012

Level of Evidence: Phase III

28-day cycles, given until progression of disease or unacceptable toxicity

Supportive medications:

References

  1. Kantarjian HM, Thomas XG, Dmoszynska A, Wierzbowska A, Mazur G, Mayer J, Gau JP, Chou WC, Buckstein R, Cermak J, Kuo CY, Oriol A, Ravandi F, Faderl S, Delaunay J, Lysák D, Minden M, Arthur C. Multicenter, randomized, open-label, phase III trial of decitabine versus patient choice, with physician advice, of either supportive care or low-dose cytarabine for the treatment of older patients with newly diagnosed acute myeloid leukemia. J Clin Oncol. 2012 Jul 20;30(21):2670-7. doi: 10.1200/JCO.2011.38.9429. Epub 2012 Jun 11. link to original article contains verified protocol PubMed

FLAG

FLAG: FLudarabine, Ara-C, G-CSF

Regimen, Montillo, et al. 1998

Level of Evidence: Phase II

  • Fludarabine (Fludara) 30 mg/m2 IV over 30 minutes once daily on days 1 to 5, given first
  • Cytarabine (Cytosar) 2000 mg/m2 IV over 4 hours once daily on days 1 to 5, given second, 4 hours after the start of fludarabine
  • Filgrastim (Neupogen) or Lenograstim (Granocyte) 5 mcg/kg SC once daily starting on day -1 (the paper described this as "day 0"), first dose given 24 hours before first dose of chemotherapy, to continue until neutrophil recovery

References

  1. Montillo M, Mirto S, Petti MC, Latagliata R, Magrin S, Pinto A, Zagonel V, Mele G, Tedeschi A, Ferrara F. Fludarabine, cytarabine, and G-CSF (FLAG) for the treatment of poor risk acute myeloid leukemia. Am J Hematol. 1998 Jun;58(2):105-9. link to original article contains verified protocol PubMed

FLAG-IDA

FLAG-IDA: FLudarabine, Ara-C, G-CSF, IDArubicin

Regimen

Level of Evidence: Phase II

References

  1. Parker JE, Pagliuca A, Mijovic A, Cullis JO, Czepulkowski B, Rassam SM, Samaratunga IR, Grace R, Gover PA, Mufti GJ. Fludarabine, cytarabine, G-CSF and idarubicin (FLAG-IDA) for the treatment of poor-risk myelodysplastic syndromes and acute myeloid leukaemia. Br J Haematol. 1997 Dec;99(4):939-44. PubMed
  2. Pastore D, Specchia G, Carluccio P, Liso A, Mestice A, Rizzi R, Greco G, Buquicchio C, Liso V. FLAG-IDA in the treatment of refractory/relapsed acute myeloid leukemia: single-center experience. Ann Hematol. 2003 Apr;82(4):231-5. Epub 2003 Mar 15. link to original article PubMed

Mitoxantrone & Cytarabine

Regimen, Sternberg, et al. 2000

Level of Evidence: Phase II

References

  1. Sternberg DW, Aird W, Neuberg D, Thompson L, MacNeill K, Amrein P, Shulman LN. Treatment of patients with recurrent and primary refractory acute myelogenous leukemia using mitoxantrone and intermediate-dose cytarabine: a pharmacologically based regimen. Cancer. 2000 May 1;88(9):2037-41. link to original article contains verified protocol PubMed

Mitoxantrone & Etoposide

Regimen, Ho, et al. 1988

Level of Evidence: Phase II

References

  1. Ho AD, Lipp T, Ehninger G, Illiger HJ, Meyer P, Freund M, Hunstein W. Combination of mitoxantrone and etoposide in refractory acute myelogenous leukemia--an active and well-tolerated regimen. J Clin Oncol. 1988 Feb;6(2):213-7. link to original article PubMed

MEC

MEC: Mitoxantrone, Etoposide, Cytarabine

Regimen #1, Amadori, et al. 1991

Level of Evidence: Phase II

Regimen #2, Kohrt, et al. 2010

Level of Evidence: Retrospective

References

  1. Amadori S, Arcese W, Isacchi G, Meloni G, Petti MC, Monarca B, Testi AM, Mandelli F. Mitoxantrone, etoposide, and intermediate-dose cytarabine: an effective and tolerable regimen for the treatment of refractory acute myeloid leukemia. J Clin Oncol. 1991 Jul;9(7):1210-4. link to original article PubMed
  2. Kohrt HE, Patel S, Ho M, Owen T, Pollyea DA, Majeti R, Gotlib J, Coutre S, Liedtke M, Berube C, Alizadeh AA, Medeiros BC. Second-line mitoxantrone, etoposide, and cytarabine for acute myeloid leukemia: a single-center experience. Am J Hematol. 2010 Nov;85(11):877-81. link to original article contains verified protocol PubMed
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