Management Approach to Acute Myeloid Leukemia Leveraging the Available Resources in View of the Latest Evidence: Consensus of the Saudi Society of Blood and Marrow Transplantation

Abstract

Purpose: Acute myeloid leukemia (AML) is the most prevalent acute leukemia in adults and is responsible for the majority of cancer-related mortality. In Saudi Arabia, leukemia is ranked the fifth most prevalent type of malignancy in adults. Our aim is to review existing epidemiologic data in Saudi Arabia and develop consensus guidelines for management of AML.

Methods: We review literature related to AML epidemiology, treatment patterns, and outcomes in Saudi Arabia, as well as literature related to the current advances in AML treatment. A panel of 10 experts from eight institutions in Saudi Arabia reviewed the literature and developed a consensus statement.

Result: We provide an update of the available AML epidemiologic data in Saudi Arabia and describe recent developments in the diagnostic workup, risk stratification, and treatment algorithm. The consensus recommendations for the management of AML in Saudi Arabia were developed.

Conclusion: The recommendations are in parallel with the recent international guidelines for the diagnosis and management of AML.

FIG 1

Diagnostic algorithm for AML according to the 2017 WHO classification. ^aRecurrent cytogenetic abnormalities: t(8;21), inv(16), t(16;16), t(15;17), t(9;11), t(6;9), inv(3), t(3;3), and t(1;22). ^bMDS-related cytogenetic abnormalities: Complex karyotype. Unbalanced abnormalities: –7/del(7q), –5/del(5q), i(17q)/t(17p), –13/del(13q), del(11q), del(12p)/t(12p), and idic(X)(q13). Balanced abnormalities: t(11;16), t(3;21), t(1;3), t(2;11), t(5;12), t(5;7), t(5;17), t(5;10), and t(3;5). AML, acute myeloid leukemia; AML-MRC, AML with myelodysplasia-related changes; MDS, myelodysplastic syndrome; MPN, myeloproliferative neoplasm; NOS, not otherwise specified.

FIG 2

Approach to workup of AML. AML, acute myeloid leukemia; FISH, fluorescence in situ hybridization; GO, gemtuzumab ozogamicin; LAIP, leukemia-associated immunophenotype; MFC, multiparameter flow cytometry; MPO, myeloperoxidase; MRD, measurable residual disease; PAS, periodic acid Schiff; qPCR, quantitative polymerase chain reaction.

FIG 3

Treatment algorithm for first-line therapy for patients with newly diagnosed acute myeloid leukemia. 7 + 3, 7 days of standard-dose cytarabine plus 3 days of idarubicin or daunorubicin; AML, acute myeloid leukemia; CPX-351, liposomal daunorubicin and cytarabine; GO, gemtuzumab ozogamicin; HMA, hypomethylation agent; LDAC, low-dose cytarabine.

FIG 4

Treatment algorithm for acute myeloid leukemia consolidation therapy for patients fit for intensive therapy. Allo-HCT, allogeneic hematopoietic cell transplantation; AML, acute myeloid leukemia; CPX-351, liposomal daunorubicin and cytarabine; GO, gemtuzumab ozogamicin; HiDAC, high-dose cytarabine (1.5-3 g/m²).

FIG 5

Treatment algorithm for R/R acute myeloid leukemia. Allo-HCT, allogeneic hematopoietic cell transplantation; AML, acute myeloid leukemia; CLAGM, cladribine, cytarabine, GCSF, and mitoxantrone; CR, complete remission; FLAG-IDA, fludarabine, cytarabine, GCSF, and idarubicin; GO, gemtuzumab ozogamicin; HMA, hypomethylation agent; LDAC, low-dose cytarabine; MEC, mitoxantrone, etoposide, and cytarabine; RIC, reduced-intensity conditioning; R/R, relapsed or refractory.