Prashanth, Parameswar (2014) Role of Pegylated Gowth Factor in Aml Consolidation. Masters thesis, Cancer Institute (W.I.A), Chennai.
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Abstract
Introduction: Acute myeloid leukemia is a clonal hematopoietic disorder which may be derived from either lineage specific progenitor cell or a hematopoietic stem cell. It is characterized both by a predominance of immature or mature forms of white blood cells and loss of normal hematopoiesis. It usually presents with leukocytosis or leukopenia with anemia and thrombocytopenia.(1) Epidemiology and Pathogenesis Deschler et al in his studies in 2006 found the age-adjusted incidence of AML around 3.4 cases per 100,000 persons. AML can occur in patients of any age, but in general studies have shown that the overall incidence and the proportion of acute myeloid leukemias increase with age. When childhood AML is considered, Gurney et al in his studies found maximum incidence occurs in the first year of life, and then decreases until age 4, and there after relatively remains constant until adult age group when it again starts to increase. Approximately 70% of acute leukemias in adults are AML, with a marked increase in incidence in the elderly. The increase is due to AML with MDS-related changes in marrow, which is more common with age, while the in the case of incidence of de novo AML, it remains almost same. Indian & MMTR Data As per Madras metropolitian cancer registry, incidence of acute leukemia is rising trend (2, 3). In 1984-88 it constituted 4.0% of total cancer patients. But in 2008 -2010 data, its incidence is increasing and now constitutes almost 6.9% of all cancer burdens (3). Acute myeloid leukemia constitutes the major burden of leukemia in patients with age more than 15 years. Risk Factors for AML Congenital diseases Down syndrome, Severe congenital Neutropenia, Dyskeratosis Congenita, Fanconi anemia Environmental Exposures- Ionizing radiation, Benzene exposure, Cigarette smoking Chemotherapy Topoisomerase II Inhibitors, Alkylating chemotherapy, Anthracyclines , Anti-tubulin agents Denovo AML Classification of AML (WHO 2008) (4) Acute myeloid leukemia with Genetic abnormalities AML with t (8; 21) (q22;q22); RUNX1 AML with inv (16) CBFB-MYH11 APL with t (15; 17); PML-RARA AML with t (9; 11); MLLT3-MLL Acute myeloid leukemia with Myelodysplasia-related changes Therapy-related myeloid neoplasm Acute myeloid leukemia, not otherwise Specified Risk stratification of AML (5) Acute Myeloid leukemia is presently risk stratified on basis of cytogenetic and molecular Abnormality and response to induction therapy. Fit patients (< 60-65 years, select patients up to age 75 y) are candidates of intensive therapy. Treatment includes induction therapy and Consolidation therapy. High risk-patients are evaluated for stem cell transplantation at first remission. Less fit patients (60-75 years and older, or younger patients with significant comorbidities) receive low-intensity therapy. (1) Treatment recommendations for fit AML patients < 60y or for select patients ≤ 75y (good performance status, minimal co morbidities) 1. Induction therapy: Combination of cytarabine and anthracycline is recommended [5, 6, 7, 8,] Cytarabine 100-200 mg/m2 continuous IV infusion for 7d plus Daunorubicin 60-90 mg/m2/day for 3d Follow-up bone marrow to assess remission is typically done 21-28d after completion of induction chemotherapy 2. Post remission therapy (consolidation) (9, 10,11,12, 13, 14, 15, 16, 17, 18, 19,20 ) All patients should be assessed for risk of relapse. Specific drug regimens are recommended based on a patient’s risk of relapse. Good-Risk patients: High-dose cytarabine 3 g/m2 IV over 3h every 12h on days 1, 3, and 5 for 3 cycles or Intermediate dose cytarabine 1.5gm/m2 over 3 hrs every 12 h on Day 1, 3, and 5 for 3 cycles Intermediate-risk patients: High-dose/ Intermediate dose Ara C (1.5gm/3.0 g/m2 IV) for 3 cycles or Allogeneic bone marrow transplantation High-risk patients: Allogeneic stem cell transplantation or Clinical trial or High-dose/intermediate dose cytarabine (1.5gm/3.0 g/m) IV over 3h every 12h on days 1, 3, and 5 Acute promyelocytic leukemia (APML) is disease with different biology, treated differently with a separate protocol.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Pegylated ; Gowth Factor ; Aml Consolidation. |
| Subjects: | MEDICAL > Medical Oncology |
| Depositing User: | Subramani R |
| Date Deposited: | 19 Aug 2017 03:31 |
| Last Modified: | 19 Aug 2017 03:31 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2028 |
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