As soon as the diagnosis is made, treatment is initiated.
Low risk patients have a favorable chromosome abnormality such as Inv(16), t(8;21) and t(15;17). An allogeneic stem cell transplantation is usually not appropriate for these patients in their first remission. NPMI mutation with normal cytogenetics and absence of FLT3ITD.
An unfavorable deviation may be an indication to start searching for unrelated stem cell donors early in the disease course, if the patient does not have a familial donor.
|High risk criteria for AML
||> 1 induction course
|Multiple cytogenetic defects
||Inv (3), t(3;3), -5, -7, part 5, part 7, t(9;22),
||Earlier chemotherapy and/or myelodysplastic syndrome
|Internal duplication of FLT3 gene
All others are considered standard risk.
In all patients where there is a reason to start intensive inductive treatment, the cytogenetic examination of bone marrow cells should be done at the time of diagnosis before start of treatment. This result is decisive for prognosis grouping which is central for the possible indication for an allogeneic stem cell transplantation (STC) early in the disease course.
In patients over 60 years, the result may be a guide for the intensity of the treatment which must be given when remission is achieved after induction treatment. Older patients with a cytogenetic abnormality indicating a poor prognosis hardly benefit from additional intense consolidation treatment, which causes bothersome or life-threatening complications, and little to no improvement in long-term prognosis. It is important not to over-treat the patient.
Results from cytogenetic examinations must be available when the patient is ready for consolidation treatment after induction treatment.