Acute myeloblastic leukemia(AML): Treatments

If AML is diagnosed, the following treatments should be given to the patient. Long-term use of anthracycline and cytarabine, such as daunorubicin and idarubicin, has been suggested as induction chemotherapy, and etoposide or 6-thioguanide may be used recently. However, its advantages are unclear. Studies have shown complete remission (CR) in more than 70% of all AML patients when the following treatments were administered: To maintain this condition, consolidation is required, which involves the use of two courses of high dose cytarabine (HiDAC), or allogenic hematopoietic cell transplantation (HCT) to patients with high risk cyhtogenetics on the first CR. It is recommended that HCT be used as a consolidation treatment even in patients who have received chemotherapy such as cyclophosphamide or etoposide or who have undergone radiotherapy. In fact, it is known that HCT significantly reduces the risk of recurrence of AML, but there is a question about whether it increases survival rate because allogenic HCT is a treatment with high mortality and morbidity.
Treatment of central nervous system (CNS) through intrathecal chemotherapy is important in treating patients with AML, even if CNS involvement is not identified. Cytarabine may be used as a monotherapy, but cytarabine, methotrexate, and hydrocortisone have been recently used. Cranial irradiation is effective in treating CNS leukemia, but it is not used prophylactically because it can lead to serious side effects such as endocrine or intelligence problems, secondary malignancy. In fact, the patients with CNS involvement in the AML patients were 5-10% of the total, and those with a WBC count of 2 or less, t (8; 21), inv (16), t (16; , And hepatosplenomegaly are associated with an increased risk. If CNS involvement is confirmed, it is used to treat intrathecal chemotherapy at the same time as systemic chemotherapy, and radiation is not necessarily required in this process.

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