Acute myeloid leukemia (AML) remains the most common form of acute leukemia among adults and accounts for the largest number of annual deaths due to leukemias in the United States. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for AML provide recommendations on the diagnostic evaluation and workup for AML, risk assessment based on cytogenetic and molecular features, treatment options for induction and consolidation therapies for younger and older (age ≥ 65 years) adult patients, and key supportive care considerations.

No abstract

Summary:Autologous peripheral blood stem cell transplantation following myeloablative chemotherapy is being increasingly utilized in the treatment of a variety of malignancies. We administered busulfan 16 mg/kg orally, thiotepa 500-700 mg/m 2 i.v., and carboplatin 800-1000 mg/m 2 i.v. to 56 women with metastatic carcinoma of the breast. Autologous peripheral blood stem cells, which had been collected after a combination of chemotherapy and granulocyte colony-stimulating factor, were infused on day 0. The major toxicities of the conditioning regimen included severe pancytopenia, stomatitis, nausea, emesis, diarrhea, fever, and infection. Transplant-related mortality was 1.8%. The incidence of opportunistic viral infections was 42.9%. Fourteen individuals achieved a complete response. The actuarial survival at 1223 days was 13.7% for the entire group of patients; the actuarial survival at 1009 days was 39.3% among complete responders. The functional status of the immune system was determined following transplantation in a subset of patients. Peripheral blood mononuclear cells were obtained before and after stem cell infusion, and were analyzed phenotypically and functionally. Proliferative and interleukin-2 synthetic ability of these cells was assessed following stimulation with phytohemagglutinin and anti-CD3 antibody. The response to influenza peptides was also ascertained. Proliferative and interleukin-2 synthetic capacity was markedly impaired for over a year. Memory response was virtually absent for up to 2 years following transplantation. The prolonged and marked immunosuppression following this myeloablative regimen was associated with a high incidence of opportunistic viral infections, and may have contributed to disease relapse and progression especially in patients who failed to achieve a complete response following transplantation. Keywords: myeloablative chemotherapy; breast cancer; stem cell transplant; immunosuppression Autologous peripheral blood stem cell transplantation (PBSCT) has emerged as a credible therapeutic modality in the treatment of recurrent and high-risk malignancies. [1][2][3][4] Although this form of treatment has been most successful in hematologic malignancies, some therapeutic gains have also been achieved in solid tumors, including carcinoma of the breast.5-7 Myeloablative doses of chemotherapy usually result in a prolonged period of immunologic compromise. In prior studies, it has been demonstrated that although profound and prolonged immunosuppression is a feature of all types of bone marrow transplantation (BMT), the depth and duration of immunosuppression is greatest following allogeneic BMT, intermediate after syngeneic BMT, and least following autologous BMT. 8,9 It also appears that the use of autologous PBSCT rather than autologous BMT leads to faster hematopoietic and immunologic reconstitution. 10 The implications of these findings are important and would favor a lower incidence of opportunistic infections and, conceivably, relapse of the underlying malignancy followin...