Management of persistent AML at day 14

A common occurrence in management of acute myeloid leukemia (AML) is persistence of disease in the first post-treatment marrow, typically obtained 14–21 days after initiation of therapy. Here we will briefly discuss the prognostic significance of this finding and the relative values of morphology and multiparameter flow cytometry (MPFC) in assessing persistent AML. We will then consider the therapeutic options for persistent AML: (a) repetition of the first course of therapy, most frequently 3 days of daunorubicin or idarubicin followed by 7 days of cytarabine (ara-C) (hereafter “3 + 7”), (b) change to different chemotherapy, often “high-dose ara-C” (HiDAC) +/− other agents, (c) immediate allogeneic hematopoietic cell transplantation (HCT), or (d) HiDAC with HCT done in HiDAC-induced aplasia and using a conditioning regimen other than HiDAC. Since it is generally accepted that response to azacitidine or decitabine requires several months, the remarks here principally apply to patients not given these drugs, but rather given ara-C-containing therapy.