Diagnosis AML

Previously untreated^a 

Refractory or relapsed

Refractory (No CR) or relapsed

If CR, Consolidation therapy: IDAC^d 

If CR, Consolidation therapy: Allogeneic HCT (preferred), or IDAC or autologous HCT if age <60^d 

If CR, Investigational therapy^d 

If CR, Consolidation therapy: Allogeneic HCT (alternative donor transplant if no HLA-matched donor available)^d 

If CR, Investigational therapy^d 

End

End

HCT, hematopoietic cell transplantation; HLA, human leukocyte antigen; IDAC, intermediate dose cytarabine.

^a  Risk stratification according to the European LeukemiaNet.

^b  Younger pts (<60-65 years) should routinely be offered investigational therapy on a backbone of standard chemotherapy for induction and consolidation.

^c  Older pts, especially those >65 years or with adverse-risk disease, or those who are unfit for intensive daunorubicin + cytarabine regimens, may be considered for investigational therapy alone or in combination with lower intensity chemotherapy regimens (azacitidine, decitabine).

^d  Investigational therapy as maintenance should be considered if available (after consolidation for younger pts and older pts with favorable-risk disease, and for all other older pts after induction).

Salvage treatment

Pt with primary induction failure and candidate for myeloablative allogeneic HCT or CR2 achieved with salvage treatment, and has suitable donor available

Pt with primary induction failure and candidate for myeloablative allogeneic HCT or CR2 achieved with salvage treatment, and has suitable donor available

Yes: Allogeneic HCT

No: Investigational therapy, autologous HCT considered for favorable-risk pts in CR2 with prolonged CR1 duration (>12 months)

Favorable-risk

Intermediate-risk

Adverse-risk

Either option acceptable

Induction therapy: Daunorubicin + Cytarabine-based regimen

Investigational therapy^b 

Refractory (No CR) or relapsed

If CR, Investigational therapy^d 

Either option acceptable

Induction therapy: Daunorubicin + Cytarabine-based regimen^{b  ,c} 

Investigational therapy^c 

Either option acceptable

Induction therapy: Daunorubicin + Cytarabine-based regimen^{b  ,c} 

Investigational therapy^c