Leukemia - General Treatment Approach - Induction and Consolidation Algorithm
1) Induction Chemotherapy: Starts on “day 1”.
Usually standard regimen with addition of targeted agents for patients with certain cytogenetic abnormalities. This regimen will kill both leukemia and bone marrow (BM) cells, but will not completely ablate the marrow. The goal is for healthy BM cells to recover more quickly and restore normal marrow function. Older patients (>60 yrs) receive lower-intensity therapy.
2) Day 14 Bone Marrow
Day 14, BM biopsy is performed to check for residual dz.
3) No Residual Leukemia
If BM is ablated (i.e. sufficiently acellular without evidence of residual leukemia), check for complete remission (CR) at day 28.
4) Residual Leukemia and Re-Induction Chemotherapy:
If there are residual leukemia cells, a second round of chemotherapy (re-induction) may be administered.
5) Count Recovery and Assessment for CR
During days 21-25, expect count recovery (may be delayed w/ addition of experimental therapies). Repeat BM Bx to check for CR.
6) Consolidation Therapy:
Initiated soon after remission is achieved. Goal to eradicate residual disease and sustain a lasting remission. Options include chemo or allogeneic stem cell transplant (allo-SCT), depending on patient- and disease-specific factors. In general, allo-SCT is preferred in higher risk disease, if patient is medically able to tolerate it. Chemo in lower-risk disease and in pts who are not allo-SCT candidates.
CBC every 1-3 months for 2 years, then every 3-6 months up to 5 years.
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