Patients with fever and/or other symptoms related to SARS-Cov-2 infection should have an additional test at any time. 3 + 7 regimen? Non-eligible patients: hypomethylating agents (Venetoclax)? Targeted therapy for FLT3 or IDH 1/2 mutations should be given? Mylotarg (Anti CD33) for CBF AML patients? G-CSF to shorten neutropenia? Lowering transfusion episodes, U-101017 by lowering thresholds for Hb ( 7 g/dl) and platelets ( 10 109/L)Consolidation (AML non-APL)? Eligible patients in CR after induction: reduction of the doses and cycles of cytosine-arabinoside? Non-eligible patients in CR after induction: hypomethylating agents (Venetoclax)? G-CSF and transfusion as for inductionRelapsed/refractory (AML non-APL)? Eligible patients: salvage intensive re-induction therapy? Non-eligible patients: and if non-proliferative AML, consider hypomethylating agents (Venetoclax)? Consider starting HU in proliferative AML? Targeted therapy (anti FLT3 or IDH1/2) should be given? G-CSF and transfusion as for inductionAPL? Lower-risk: ATRA and ATO as per standard treatment? High-risk: ATRA and ATO added to cytoreductive chemotherapy as per standard treatment? If ATO not available, ATRA and anthracyclinesAllogeneic transplant? No delay Open in a separate window Testing for SARS-Cov-2 Testing should be performed for all newly diagnosed AML patients, and at the start of the next treatment cycle. Patients with fever and/or other symptoms related to SARS-Cov-2 infection should have an additional test at any time. Donor and recipient for allogeneic transplant should also be tested before the procedure. Induction Therapy for AML (Non-APL) Intensive induction chemotherapy should still be offered for eligible patients with 3 + 7 (anthracyclines for 3 days and cytosine- arabinoside for 7 days) or similar regimens (11). Fludarabine combination should be avoided because of the deep immunosuppression effect of this drug. For the other patients, non-chemotherapeutic induction could be hypomethylating agents with or without low doses of cytosine-arabinoside (12). Adding of venetoclax to hypomethylating agents can be considered but at lower doses of venetoclax because the combination could induce long phases of aplasia (12C14). This combination can also be administered as alternative to chemotherapy in patients with positive NPM1 mutation because of high rate of durable complete remission (CR) obtained (15). Furthermore, venetoclax based regimens can be given for any non-CBF elderly patient ( 60 year-old), or patient over 50 U-101017 year-old with MPN1 or IDH1/2 mutations (14). Mylotarg (antiCD33) can be administered to CBF AML patients U-101017 in combination with U-101017 3 + 7 regimen due to the significant improvement of survival in these patients with this combination. Myelotarg is omitted from chemotherapy combination for intermediate- and high-risk patients (16, 17). Other targeted therapies (e.g., Anti FLT3 or anti IDH1/2) when indicated should be administered. Consolidation Therapy for AML (Non-APL) For eligible patients with CR after induction chemotherapy, consolidation with high-dose cytosine-arabinoside based regimens should be offered, but reducing the dose of cytosine-arabinoside (e.g., 1.5/m2 instead of 3 g/m2 per dose) and decreasing the number of cycles to 2C3 instead of four are considered, since randomized studies showed disease-free-survival U-101017 (DFS) advantage only in favorable cytogenetic risk patients at higher doses (3 g/m2) of cytosine-arabinoside (18). For the other patients, hypomethylating agents could be given. Relapse/Refractory AML (Non-APL) Standard intensive regimens are used Rabbit polyclonal to TNFRSF10D for eligible patients. For the other patients, and if the disease is not proliferative re-induction therapy could be temporarily postponed. Hydroxyurea (HU) could be given if the disease in proliferation awaiting re-induction therapy. Targeted therapy (hypomethylating agents, venetoclax, anti FLT3 or anti IDH1/2, etc) can be administered. Supportive Care.