急性髓細胞白血病2022.v1（英文）-NCCN腫瘤臨床實踐指南

NCCNClinicalPracticeGuidelinesinOncologyNCCNGuidelines?)AcuteMyeloidLeukemiarsionDecemberNCCNGuidelinesforPatients?availableat/patientsVersion1.2022,12/02/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon3/14/20227:26:15AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.NCCNGuidelinesVersion1.2022AcuteMyeloidLeukemia(Age≥18years)dex*DanielA.Pollyea,MD,MS/Chair?T?UniversityofColoradoCancerCenterJessicaK.Altman,MD/ViceChair?RobertH.LurieComprehensiveCancerCenterofNorthwesternUniversityVijayaRajBhatt,MBBS?ξFred&PamelaBuffettCancerCenterDaleBixby,MD,PhD??TUniversityofMichiganRogelCancerCenterHettyCarraway,MD,MBA?CaseComprehensiveCancerCenter/UniversityHospitalsSeidmanCancerCenterandClevelandClinicTaussigCancerInstituteAmirT.Fathi,MD??MassachusettsGeneralHospitalCancerCenterJamesM.Foran,MD?MayoClinicCancerCenterIvanaGojo,MD?TheSidneyKimmelComprehensiveCancerCenteratJohnsHopkinsAricC.Hall,MD??ξUniversityofWisconsineCancerCenterMeaganJacoby,MD,PhD??ξSitemanCancerCenteratBarnes-JewishHospitalandWashingtonUniversitySchoolofMedicineBrianA.Jonas,MD,PhD?UCDavisComprehensiveCancerCenteresPanelDisclosuresJeffreyLancet,MD??MoffittCancerCenterJamesMangan,MD?UCSanDiegoMooresCancerCenterGabrielMannis,MD?TStanfordCancerInstituteGuidoMarcucci,MD?TCityofHopeNationalMedicalCenterAliceMims,MD,MS?TheOhioStateUniversityComprehensiveCancerCenter-JamesCancerHospitalandSoloveResearchInstituteJadeeNeff,MD,PhD≠DukeCancerInstituteRezaNejati,MD≠FoxChaseCancerCenterRebeccaOlin,MD,MS?ξUCSFHelenDillerFamilyComprehensiveCancerCenterPraptiPatel,MD?UTSouthwesternSimmonsComprehensiveCancerCenterMary-ElizabethPercival,MD,MS?FredHutchinsonCancerResearchCenter/SeattleCancerCareAllianceAlexanderPerl,MD?AbramsonCancerCenterattheUniversityofPennsylvaniaAmandaPrzespolewski,DO?RoswellParkComprehensiveCancerCenterDineshRao,MD,PhD≠UCLAJonssonComprehensiveCancerCenterFarhadRavandi,MDT?TheUniversityofTexasPaulJ.Shami,MD?HuntsmanCancerInstituteattheUniversityofUtahRichardM.Stone,MD??Dana-Farber/BrighamandWomen’senterStephenA.Strickland,MD,MSCI?Vanderbilt-IngramCancerCenterKendraSweet,MD,MS?T?MoffittCancerCenterMartinTallman,MD?MemorialSloanKetteringCancerCenterSwapnaThota,MD?St.JudeChildren'sResearchHospital/TheUniversityofTennesseeHealthScienceCenterPankitVachhani,MD?O'NeilComprehensiveCancerCenteratUABCampbellPhD?TξBonemarrow?T*Hematology/*InternalmedicineMedicaloncologyPathologyDiscussionSectionWritingCommitteeMemberVersion1.2022,12/02/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.eatmentofCNSLeukemia?PrinciplesofRadiationTherapy(AML-C)?GeneralConsiderationsandSupportiveCareforAMLPatientsWhoPreferNottoeatmentofCNSLeukemia?PrinciplesofRadiationTherapy(AML-C)?GeneralConsiderationsandSupportiveCareforAMLPatientsWhoPreferNottoReceiveBloodTransfusions(AML-D)?PrinciplesofSupportiveCareforAML(AML-E)?MonitoringDuringTherapy(AML-F)?Measurable(Minimal)ResidualDiseaseAssessment(AML-G)?ResponseCriteriaDefinitionsforAcuteMyeloidLeukemia(AML-H)?TherapyforRelapsed/RefractoryDisease(AML-I)?PrinciplesofVenetoclaxUsewithHMAorLDAC(AML-J)?Introduction(BPDCN-INTRO)?Evaluation/Workup(BPDCN-1)?Treatment(BPDCN-2)?SurveillanceandTreatmentforRelapsed/RefractoryDisease(BPDCN-3)?PrinciplesofBPDCN(BPDCN-A)?EvaluationandTreatmentofCNSDisease(BPDCN-B)?PrinciplesofSupportiveCareforBPDCN(BPDCN-C)NCCNGuidelinesVersion1.2022AcuteMyeloidLeukemia(Age≥18years)dexlievesthatthebestmanagementlievesthatthebestmanagementforanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.FindanNCCNMemberInstitution:/home/member-institutions.ofEvidenceandsusAllrecommendationsotherwisedNCategoriesofEvidenceandConsensus.NCCNCategoriesofPreference:Allrecommendationsareconsideredappropriate.SeeNCCNCategoriesofPreference.SummaryofGuidelinesUpdatesMLeticsMLeticsinNonAPLAMLPL?ClassificationandTreatmentRecommendations(APL-1)?Low-RiskTreatmentInductionandConsolidationTherapy(APL-2)?High-RiskInductionandConsolidationTherapy(APL-3)?Post-ConsolidationTherapyandMonitoring(APL-5)?TherapyforRelapse(APL-6)?PrinciplesofSupportiveCare(APL-A)ML?(Age<60y)TreatmentStrategiesandInduction(AML-1)?(Age<60y)RiskStatusandConsolidationTherapy(AML-4)?(Age≥60y)TreatmentStrategiesandInduction-CandidatesforIntensiveTherapy(AML-5)?(Age≥60y)TreatmentStrategiesandInduction-Non-CandidatesforIntensiveTherapy(AML-6)?(Age≥60y)AfterStandard-DoseCytarabineInduction(AML-7)?(Age≥60y)Post-InductionTherapy-PreviousIntensiveTherapy(AML-8)?(Age≥60y)Post-InductionTherapy-PreviousLowerIntensityTherapy(AML-9)?MaintenanceTherapy(AML-10)?AMLSurveillanceandTherapyforRelapsed/RefractoryDisease(AML-11)TheNCCNGuidelinesareastatementofevidenceandconsensusoftheauthorsregardingtheirviewsofcurrentlyacceptedapproachestotreatment.AnyclinicianseekingtoapplyorconsulttheNCCNGuidelinesisexpectedtouseindependentmedicaljudgmentinthecontextofindividualclinicaltancestodetermineanypatientscareortreatmentTheNationalComprehensiveCancerNetworkNCCNmakesnorepresentationsorwarrantiesofanykindregardingtheircontentuseorapplicationanddisclaimsanyresponsibilityfortheirapplicationoruseinanyway.TheNCCNbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.?2021.Version1.2022,12/02/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon3/14/20227:26:15AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.NCCNGuidelinesVersion1.2022AcuteMyeloidLeukemia(Age≥18years)dexheNCCNGuidelinesforAcuteMyeloidLeukemiafromVersionincludeuationp3rdbulletadded:B12andfolicacidevaluationp14thbulletadded:Considerearlyintegrationofpalliativecare(SeeNCCNGuidelinesforPalliativeCare)?DiagnosispAPLrevised:InpatientswithclinicalandorpathologicfeaturesofAPLpAML,1stsub-bulletrevised:...cytarabine(1-2g)maybeconsideredpriortoreceivingdiagnosticresultsEVAL-1A?Footnotearevised:...decision-making(category2B)(SeeAML-A).Othergeneticlesions,suchasASXL1,BCR-ABL,andPML-RARalpha(SeeAML-A)mayhavetherapeuticimplicationssignificance...WhiletheaboveMutationsshouldbetestedinallpatients...?Footnotecadded:El-JawahriA,etal.JAMAOncol2021;7:238-245.AcutePromyelocyticLeukemia(Age≥18years)APL-2?APL(LowRisk)pTreatmentinduction,PreferredRegimen,1stand2ndpathwaysrevised:ATRA45mg/m2in2divideddosesdaily+arsenictrioxide...pConsolidationtherapy,2ndrowrevised:First3consolidationcycles=56daycycles;ATRA45mg/m2/dPOdividedintoin2divideddailydoseson...pTreatmentinduction,UsefulinCertainCircumstances,3rdpathwayrevised:ATRA45mg/m2in2divideddosesdaily+idarubicin...pConsolidationtherapy,4thpathwayrevised:ATRA45mg/m2in2divideddosesdailymaybegivenmonthlyuntil28weeksfromcompleteresponse(CR)untilachievementofcompletemolecularresponse.APL-3?APL(HighRisk),Treatmentinduction,ATRAregimenwasclarifiedasappropriate:ATRA45mg/m2in2divideddosesdaily...APL-3A?Footnotepadded:ItisimportantforthemanagementofAPLthatregimenscontainingATRAandarsenictrioxidebeadministeredunlessthereisacontraindicationbasedonareextenuatingpatientcircumstances.ItisimportantforregimenscontainingATRAandarsenictrioxidetobeadministeredforthemanagementofAPL.Ifarsenicisnotavailableorcontraindicated,itmaybeomittedfrominduction.?Footnotesadded:Noarsenicisincludedininductionifunavailableorcontraindicated.?Footnotexrevised:Consider4–6dosesofITchemotherapy(eg,2dosesforeachconsolidationcycle)asanoptionforCNSprophylaxis.APL-4?APL(HighRisk)inPatientswithCardiacIssuespTreatmentinduction,ATRAregimenwasclarifiedasappropriate:ATRA45mg/m2in2divideddosesdailypConsolidationTherapy,ProlongedQTc?1stpathway:ATRA45mg/m2in2divideddosesuntil28weeksfromCRuntilachievementofcompletemolecularresponse.?3rdpathway:...+cytarabine150mg/m2/8hover8hx4daysx1cycle.APL-4A?Footnoteremoved:ForpatientswhohaveprolongedQTcastheirsolecomorbidity,gemtuzumabozogamicincouldbesubstitutedforanthracycline.UPDATESVersion1.2022,12/02/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon3/14/20227:26:15AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.NCCNGuidelinesVersion1.2022AcuteMyeloidLeukemia(Age≥18years)dexheNCCNGuidelinesforAcuteMyeloidLeukemiafromVersionincludeAcutePromyelocyticLeukemia(Age≥18years)(continued)APL-5?Footnotebbadded:GrimwadeD,etal.JClinOncol2009;27:3650-3658.APL-6?Footnoteddadded:CicconiL.etal.AnnHematol2018;97:1797-1802.APL-A?PrinciplesofSupportiveCareforAPLp3rdbullet,2ndsub-bulletrevised:dexamethasone10mgq12h(SeeNCCNPreventionandTreatmentofCancer-RelatedInfections).pFootnote1added:Antiviralprophylaxiszosterfordurationoftreatmentmaybeappropriate.FreyerCW,etal.LeukLymphoma2021;62:696-702;GlassJL,etal.Blood2015;126:3752–3752.pFootnote2added:DaverN,etal.BrJHaematol2015;168:646-53.AcuteMyeloidLeukemia(Age≥18years)AML-1?General:PhysiologicwasremovedfromagethroughoutAMLsection?Headerclarifiedas:Age<60y,Inductioneligible?TreatmentStrategiesp2ndqualifierrevised:Intermediate-riskcytogeneticsandFLT3-mutated(ITDorTKD)toFLT3/ITD/TKDwithintermediatepoor-riskgeneticsAML-1A?Footnotecrevised:PatientswithCBF-AMLandcoreabnormalitiesmaybenefitfromtheadditionofgemtuzumabozogamicinGemtuzumabozogamicinisnotbeneficialinpatientswithadverseriskAML.?Footnotedadded:BorlenghiE,etal.JGeriatrOncol2021;12:550-556.?Footnoteeadded:ForCBF-AMLleukemiawithFLT3mutation,thepanelprefersgemtuzumabozogamicin.?Footnotefadded:GemtuzumabozogamicinmaybebeneficialinNPM1-mutatedAML(Kapp-SchwoererS,etal.Blood2020;136:3041-3050).?Footnotepadded:AnFDA-approvedbiosimilarisanappropriatesubstituteforfilgrastim.?Footnotesadded:Outcomeswithunfavorable-riskcytogeneticsandTP53-mutatedAMLremainpoorwithconventionalinductionchemotherapy(RückerFG,etal.Blood2012;119:2114-2121).Considerclinicaltrials,azacitidine/venetoclax(DiNardoCD,etal.NEnglJMed2020;383:617-629),ora10-daycourseofdecitabine(WelchJS,etal.NEnglJMed2016;375:2023-2036).?Footnoteurevisedbyremoving:However,onestudyshowedthathigh-dosecytarabinemayimprovetheoutcomeforyoungerpatients.WillemzeR,etal.JClinOncol2014;32:219-228.AML-2-AGE<60yAFTERSTANDARD-DOSECYTARABINEINDUCTION/RE-INDUCTION?Significantcytoreductionwithlow%residualblasts,3rdbulletadded:Intermediateorhigh-dosecytarabineVersion1.2022,12/02/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.UPDATESPOoncedailyondaysofeachdaycycleuntilprogressionorunacceptabletoxicityifpatientsPOoncedailyondaysofeachdaycycleuntilprogressionorunacceptabletoxicityifpatientstenancedeclineorarenotfiteligibleforallogeneicHCT)NCCNGuidelinesVersion1.2022AcuteMyeloidLeukemia(Age≥18years)dexheNCCNGuidelinesforAcuteMyeloidLeukemiafromVersionincludeAML-4eNPMpositiveFLTnegativeAML-5FootnoteremovedfrompageInpatientswithAMLwithTP53mutation,a10-daycourseofdecitabinemaybeconsidered(WelchFootnoteremovedfrompageInpatientswithAMLwithTP53mutation,a10-daycourseofdecitabinemaybeconsidered(WelchJS,etal.NEnglJMed2016;375:2023-2036).ResponsemaynotbeevidentbeforeNEnglJMed2016;375:2023-2036).Responsemaynotbeevidentbefore3–4cyclesoftreatmentwithHMAs(ie,azacitidine,decitabine).reatmentuntilprogressionifpatientistoleratingtherapySimilardelaysinresponsearelikelywithnovelagentsinaclinicaltrial,butendpointswillbedefinedbytheprotocol.TMENTINDUCTION?IDH1orIDH2mutation,forbothpreferredandotherrecommended,thevenetoclax-basedregimenmovedtofirstbullet.?Footnoteeeeadded:DiNardoCD,etal.NEnglJMed2020;383:617-629.AML-8?Post-Remission/MaintenanceTherapyheaderrevisedasPost-InductionTherapy?Aftercompleteresponse,thepathwaywassplitby"Abletoreceiveconventionalconsolidation"and"Notabletoreceiveanyorallofrecommendedconsolidation?Maintenancetherapyoptionsmovedtonotabletoreceiveanyorallofrecommendedconsolidation.toxicitywaschangedfromacategory2Atoacategory1,preferredgressiondecitabinechangedfromacategoryAtoacategory2Brecommendation.ntendedtoreplaceconsolidationchemotherapywhichcanbecurativeinsomecasesInadditionfitpatientswithbecurativeinsomecasesInadditionfitpatientswithintermediateand/oradverse-riskcytogeneticsmaybenefitfromHCTinfirstCR,erearenodatatosuggestthatmaintenancetherapywithoralazacitidinecanreplaceHCTThepanelalsonotesthatthetrialdidnotincludeyoungerpatientsorthosewithwithCBFAMLitwasrestrictedtopatients≥55yearsofagewithintermediateoradverseticswhowerenotfelttobecandidatesforHCTMostpatientsreceivedatleastcycleofconsolidationpriortostartingoralazacitidineWeiAHetalBloodSupplLBAWeiAHetalNEnglJMed2020;383:2526-2537."FootnoteooowasrevisedAnoptionforpatientswhohadachievedaremissionwithamoreintensiveregimenbuthadregimen-relatedtoxicitythatpreventedthemfromreceivingmoreconventionalconsolidation.Azacitidine:HulsG,etal.Blood2019;133:1457-1464;DecitabineBoumberYetalLeukemia428–3241.AML-10MAINTENANCETHERAPYgeneicstemcelltransplantationinremissionandhistoryofFLTITDwiththeoptionofFLTinhibitormaintenancewithsorafenibasacategory2Arecommendation.Clarifiedcriteriafororalazacitidineashemotherapyandisnowinremissiononsomeconsolidationorarecommendedcourseofconsolidationandtisplanned?Added:Neitheroftheabovescenariosisapplicablewiththerecommendationformaintenancetherapyasnotrecommended.Version1.2022,12/02/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.UPDATESUPDATESVersion1.2022,12/02/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon3/14/20227:26:15AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.NCCNGuidelinesVersion1.2022AcuteMyeloidLeukemia(Age≥18years)dexUpdatesinVersion1.2022oftheNCCNGuidelinesforAcuteMyeloidLeukemiafromVersion3.2021include:AML-A2of4FAMILIALGENETICALTERATIONSINAML?NewpageaddedrelatedtopredispositiontoAML.AML-H-RESPONSECRITERIADEFINITIONSFORACUTEMYELOIDLEUKEMIA?Statementadded:Theseresponsecriteriaweredefinedinthecontextofintensivechemotherapyregimens,andmaynotbepredictiveofoutcomesforpatientswhoreceiveothertherapies.AML-I-THERAPYFORRELAPSED/REFRACTORYDISEASE?Footnote8added:AnFDA-approvedbiosimilarisanappropriatesubstituteforfilgrastim.AML-J-PRINCIPLESOFVENETOCLAXUSEWITHHMAORLDAC?General,2ndbulletrevisedfrom,"ReductionindurationofHMAandLDACorvenetoclaxtreatmentcanbeconsidered,particularlywhentherearedelaysincountrecovery"to"Wheretherearedelaysincountrecovery,reductionindurationofvenetoclaxand/orreductionindoseordurationofHMAorLDACshouldbeconsidered."?TherapyforNewlyDiagnosedPatientspPriortotherapysub-bulletsrevised:?Todecreasetheriskofseveretumorlysissyndrome(TLS),aimtrytoachieveWBCcountof<25,000/mcLwithhydroxyurea/leukapheresisifnecessary.?AdministerInitiateboththerapiesofthecombinationconcomitantly.?IfazoleantifungalprophylaxisorotherCYPenzymeinteractingmedicationsareconcurrentlyindicated,reducevenetoclaxdoseaccordingly.pFirstCycleConsiderations?TLSmonitoring,2ndsub-bulletrevisedbyadding:Concomitantinteractingmedicationsmayrequirechangestothesedosages.?TLSmonitoring,4thsub-bulletrevised:Forpatientswithproliferativedisease,monitorbloodchemistriesevery6–8hoursafterinitiation;ifwithinnormallimits,recheckoncedailyandcontinuemonitoringuntilnofurtherriskofTLS.?3rdsub-bulletrevised:Ifnomorphologicremission(persistentmarrowblastsabove5%)...pCycle2andbeyond?3rdsub-bulletadded:Ifpersistentdiseaseaftercycle1,repeatmarrowbiopsyfollowingcycle2(orsubsequentcyclesuntilNEDorremission)toagainassessforcellularityanddiseaseresponse,anddeterminetimingofsubsequentcycle.?6thsub-bulletrevised:Ifnomorphologicremissionaftercycle2or3,thelikelihoodofresponseisdecreasedandpatientscouldconsidersmacytoidDendriticCellNeoplasmEvaluationWorkupthbulletrevisedfromLPtoruleoutCNSdisease;followwithITprophylaxisifclinicallyindicated"to"AllpatientsrequireadiagnosticLPatthetimeofinitialdiagnosisatdiseaserelapseoranyothertimewhenthereisaclinicalsuspicionforCNSinvolvementFollowwithITtreatmentprophylaxisasclinicallyindicated(seeBPDCN-B)."BPDCN-B-EVALUATIONANDTREATMENTOFCNSDISEASE?RecommendationsaddedfortreatmentwithandwithoutCNSdisease?Comprehensivepathologyreport,includingdiagnosisofAMLwithrecurrentcytogeneticsvs.AMLNOS,blastcount,cellularity,morphologicdysplasia,andmutationstatusifavailable?Humanleukocyteantigen(HLA)typingforpatientwithpotentialhematopoieticcelltransplantation(HCT)?Comprehensivepathologyreport,includingdiagnosisofAMLwithrecurrentcytogeneticsvs.AMLNOS,blastcount,cellularity,morphologicdysplasia,andmutationstatusifavailable?Humanleukocyteantigen(HLA)typingforpatientwithpotentialhematopoieticcelltransplantation(HCT)inthefuture(exceptforpatientswithamajorcontraindicationtoHCT)and/orearlyreferraltotransplantcenterBrainCTwithoutcontrastifcentralnervoussystemhagesuspectedbSeeAMLBBrainMRIwithcontrast,ifleukemicmeningitisedbSeeAMLBcionforextramedullaryMLB?Lumbarpuncture(LP),ifsymptomaticb(category2Bforasymptomatic)?Evaluatemyocardialfunction(echocardiogramorMUGAscan)inpatientswithahistoryorsymptomsofcardiacdiseaseorprior/plannedexposuretocardiotoxicdrugsorradiationtothorax?Considerearlyintegrationofpalliativecarec(SeeinesforPalliativeCarecationdationstificationandmendationsMLelinesforplasticsAcuteaNCCNGuidelinesVersion1.2022AcuteMyeloidLeukemia(Age≥18years)dexEVALUATIONFORAML?Historyandphysical(H&P)?Completebloodcount(CBC),platelets,differential,comprehensivemetabolicpanel,uricacid,lactatedehydrogenase(LDH)?B12andfolicacidevaluation?Prothrombintime(PT),partialthromboplastintime(PTT),fibrinogen?Bonemarrow(BM)corebiopsyandaspirateanalyses,includingimmunophenotypingbyimmunohistochemistry(IHC)stains+flowcytometryandcytogeneticanalyses(karyotype+FISH)(SeeAML-A)?Molecularanalyses(ASXL1,c-KIT,FLT3[ITDandrmutationsaSeeAMLATKD],NPM1rmutationsaSeeAMLADIAGNOSISd,eDIAGNOSISd,e,f,gAcutepromyelocyticleukemia(APL):ntswithclinicalorpathologicfeaturesSTUDIES(WHO2016)etinoicacidATRAetinoicacidATRAuponfirstsuspicionofAPL.hEarlyinitiationofventthelethalcomplicationofbleedinghIfcytogeneticandmoleculartestingtmentasforAMLToappropriatelystratifyavailableintensivetherapyoptions,expeditetestresultsofmolecularandcytogeneticanalysesforimmediatelyactionablemutationsorchromosomalabnormalities(eg,CBF,FLT3ary[ITDandTKD],NPM1,IDH1,IDH2aryic?Forpatientswithiciesdeuncontrolledwithiesdeleukapheresis,onedoseofintermediate-dosecytarabine(1–2g)maybeconsideredpriortoreceivingdiagnosticresults?Forpatientswhoprefernottoreceivebloodtransfusion(s),seeAML-DforgeneralconsiderationsandsupportivecareForsuspicionofblasticplasmacytoiddendriticcellneoplasm(BPDCN),seeBPDCN-INTROMyelodysplasticsyndromes(MDS)maeasticmaeAevaluationofBPDCNseeBPDCNNote:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.EVAL-1Version1.2022,12/02/21?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsre