Division of Hematology, University of Washington, Seattle, Washington.
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Am J Hematol. 2020 Nov;95(11):1368-1398. doi: 10.1002/ajh.25975.
Management of AML involves choosing between purely palliative care, standard therapy and investigational therapy ("clinical trial"). Even most older patients likely benefit from treatment. Based on randomized trials CPX 351, midostaurin, gemtuzumab ozogamicin, and venetoclax, the latter three when combined with other drugs, should now be considered standard therapy. Knowledge of the likely results with these therapies is essential in deciding whether to recommend them or participate in a clinical trial, possibly including these drugs. Hence here, in the context of established prognostic algorithms, we review results with the recently- approved drugs compared with their predecessors and describe other potential options. We discuss benefit/risk ratios underlying the decision to offer allogeneic transplant and emphasize the importance of measurable residual disease. When first seeing a newly-diagnosed patient physicians must decide whether to offer conventional treatment or investigational therapy, the latter preferably in the context of a clinical trial. As noted below, such trials have led to changes in what today is considered "conventional" therapy compared to even 1-2 years ago. In older patients decision making has often included inquiring whether specific anti-AML therapy should be offered at all, rather than focusing on a purely palliative approach emphasizing transfusion and antibiotic support, with involvement of a palliative care specialist.
AML 的治疗包括在姑息治疗、标准治疗和试验治疗（“临床试验”）之间进行选择。即使是大多数老年患者也可能从治疗中获益。基于随机试验 CPX 351、米哚妥林、吉妥珠单抗奥佐米星和维奈托克，后三种药物与其他药物联合使用时，现在应被视为标准治疗。在决定是否推荐这些治疗方法或参加临床试验（可能包括这些药物）时，了解这些治疗方法的可能结果至关重要。因此，在这里，我们根据既定的预后算法，回顾了最近批准的药物与它们的前身相比的结果，并描述了其他潜在的选择。我们讨论了提供异基因移植背后的获益/风险比，并强调了可测量残留疾病的重要性。当首次见到新诊断的患者时，医生必须决定是提供常规治疗还是试验治疗，后者最好在临床试验的背景下进行。如下所述，与 1-2 年前相比，此类试验导致了今天被认为是“常规”治疗的变化。在老年患者中，决策通常包括询问是否应提供特定的抗 AML 治疗，而不是专注于强调输血和抗生素支持的纯姑息治疗方法，并涉及姑息治疗专家。
