Establish intent of treatment

• Curative
• Anti-leukaemia therapy to improve quality of life and/or longevity without expectation of cure
• Symptom palliation including active supportive care

Treatment options to induce remission

Patients fit for intensive chemotherapy: Induction chemotherapy should ideally only be started when all diagnostic criteria have been satisfied. Once patients are in remission, consolidation therapy is always indicated when cure is the intention.

Patients not fit for intensive chemotherapy: Referral to a clinical trial should be a priority. Available treatment options include low-dose chemotherapy, hypomethylating agents for select patients, or palliative/supportive care to control symptoms.

Allogeneic stem cell transplant: Should be considered for select patients (refer to the AML optimal care pathway).

Radiation therapy: May be used for symptom control and occasionally for treating extramedullary disease.

Other treatment options

Acute promyelocytic leukaemia

Rapid initiation of APL-specific therapy is essential and, in some cases, may precede formal confirmation of the diagnosis.

Refractory disease

• Allogeneic stem cell transplant for select patients.
• Palliative systemic treatment is often a reasonable option.
• Clinical trials and experimental therapy should be considered.

Palliative care

Early referral to palliative care can improve quality of life and in some cases survival. Referral should be based on need, not prognosis. For more, visit the Palliative Care Australia website.

Communication

The lead clinician and team’s responsibilities include:

• discussing treatment options with the patient and/or carer including the intent of treatment as well as risks and benefits
• discussing advance care planning with the patient and/or carer where appropriate
• communicating the treatment plan to the patient’s GP
• helping patients to find appropriate support for exercise programs where appropriate to improve treatment outcomes.

Checklist

Timeframe

Induction therapy should begin promptly after diagnosis and confirmation of a treatment plan.

Consolidation therapy should begin within six weeks of induction chemotherapy starting.

Donor searches should begin as soon as the patient’s risk status is known.