Гострий мієлоїдний лейкоз (не-APL)
Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.
| ID | DIS-AML |
|---|---|
| Тип | Хвороба |
| Синоніми | AMLANLLAcute Myeloid LeukemiaAcute non-lymphocytic leukemiaГострий мієлобластний лейкозГострий мієлоїдний лейкоз (не-APL) |
| Статус | переглянуто 2026-04-25 | очікує клінічного підпису |
| Хвороби | Не вказано |
| Джерела | SRC-ELN-AML-2022 SRC-ESMO-AML-2020 SRC-NCCN-AML-2025 |
Інформаційна підтримка. Усі рекомендації має перевірити кваліфікований онколог. Технічні перевірки не є клінічною валідацією чи схваленням лікування.
| icd_o_3_morphology | 9861/3 |
|---|---|
| icd_o_3_topography | ["C42.1"] |
| icd_10 | C92.0 |
| who_classification | Acute myeloid leukemia (per WHO 5th ed. / ICC 2022) — non-APL subtypes |
Нотатки
Архетип ризик-стратифікованої терапії. Принциповий розподіл лікування — придатність до інтенсивної індукції 7+3 (вік, коморбідність, ECOG). У придатних пацієнтів за наявності FLT3-ITD/TKD до схеми лікування додають мідостаурин (midostaurin) на підставі дослідження RATIFY; у непридатних стандартом першої лінії є комбінація венетоклакс (venetoclax) + азацитидин (azacitidine) (VIALE-A). APL (PML-RARA) є окремою нозологічною одиницею з принципово відмінною терапією (ATRA + ATO) — див. DIS-APL. STUB — потребує підтвердження клінічними співкерівниками до публікації. Мієлоїдна експансія (heme) — перша мієлоїдна нозологія, опрацьована наскрізно.
Де використовується
Algorithms
ALGO-AML-1L- ALGO-AML-1LALGO-AML-2L- ALGO-AML-2L
Questionnaires
QUEST-AML-1L-STUB- Acute Myeloid Leukemia — first line
Sources
SRC-ADMIRAL-PERL-2019- Gilteritinib or Chemotherapy for Relapsed or Refractory FLT3-Mutated AMLSRC-AG221-AML-001- Enasidenib in mutant IDH2 relapsed or refractory acute myeloid leukemiaSRC-AGILE-MONTESINOS-2022- Ivosidenib and Azacitidine in IDH1-Mutated Acute Myeloid LeukemiaSRC-ALFA-0701-CASTAIGNE-2012- Effect of gemtuzumab ozogamicin on survival of adult patients with de-novo acute myeloid...SRC-AUGMENT-101- Menin Inhibition With Revumenib for KMT2A-Rearranged Relapsed or Refractory Acute Leukemi...SRC-ELN-AML-2022- Diagnosis and management of AML in adults: 2022 ELN recommendations from an international...SRC-ESMO-AML-2020- Acute myeloid leukaemia in adult patients: ESMO Clinical Practice Guidelines for diagnosi...SRC-IDHENTIFY- Enasidenib vs Conventional Care in Older Patients With Late-Stage Mutant-IDH2 Relapsed/Re...SRC-LANCET-CPX351-2018- CPX-351 (cytarabine and daunorubicin) Liposome for Injection vs Conventional Cytarabine P...SRC-QUANTUM-FIRST-ERBA-2023- Quizartinib plus chemotherapy in newly diagnosed patients with FLT3-internal-tandem-dupli...SRC-QUAZAR-WEI-2020- Oral azacitidine maintenance therapy for acute myeloid leukemia in first remission (QUAZA...SRC-RATIFY-STONE-2017- Midostaurin plus Chemotherapy for Acute Myeloid Leukemia with a FLT3 MutationSRC-VIALE-A-DINARDO-2020- Azacitidine and Venetoclax in Previously Untreated Acute Myeloid Leukemia
Клінічна застосовність
BMA-BCL2-EXPRESSION-AML- Venetoclax (BCL2 inhibitor) + azacitidine or decitabine is FDA-approved (Oct 2020) for ne...BMA-BRAF-V600E-AML- BRAF V600E in AML is rare (<1%, more in histiocytic disorders / mixed-phenotype acute leu...BMA-FLT3-D835-AML- FLT3-D835 (TKD) in newly-diagnosed AML: midostaurin + 7+3 was studied in FLT3-mutant (ITD...BMA-FLT3-D835-AML-RR- FLT3-D835 in R/R AML: gilteritinib superior to salvage chemo (ADMIRAL, Perl 2019 — pre-sp...BMA-FLT3-F691L-AML- FLT3-F691L is a gatekeeper mutation arising under FLT3-TKI selective pressure (gilteritin...BMA-FLT3-ITD-AML- FLT3-ITD in newly-diagnosed AML: midostaurin + 7+3 induction + high-dose cytarabine conso...BMA-FLT3-ITD-AML-RR- FLT3-ITD in relapsed/refractory AML: gilteritinib monotherapy superior to salvage chemo (...BMA-IDH1-R132C-AML- IDH1 R132C — same therapeutic implications as R132H; ivosidenib targets all R132 variants.BMA-IDH1-R132G-AML- IDH1 R132G — covered by IDH1-mut label (any R132).BMA-IDH1-R132H-AML- IDH1 R132 mutations (~6-10% of AML). Ivosidenib monotherapy (AGILE, Montesinos et al. NEJ...BMA-IDH1-R132L-AML- IDH1 R132L — covered by IDH1-mut label.BMA-IDH1-R132S-AML- IDH1 R132S — covered by IDH1-mut label.BMA-IDH2-R140Q-AML- IDH2 R140Q (~5-9% of AML). Enasidenib (IDHIFA, AG221-C-001 Stein et al. Blood 2017) FDA-a...BMA-IDH2-R172K-AML- IDH2 R172K — slightly different metabolic profile but same enasidenib indication.BMA-KIT-MUTATION-AML- KIT mutation in core-binding-factor (CBF) AML (t(8;21) / inv(16)) is enriched (~25-30%) a...BMA-KMT2A-REARR-AML- Revumenib (SNDX-5613), an oral menin inhibitor, is FDA-approved (Nov 2024) for relapsed/r...BMA-NPM1-AML- NPM1-mutated AML is a distinct WHO 2022 / ICC 2022 entity and ELN 2022 favorable-risk cat...BMA-NRAS-G12-AML- NRAS G12/G13 in AML — common in pediatric AML and JMML; not directly targeted.BMA-NRAS-G13-AML- NRAS G13 in AML — same rationale.BMA-NRAS-Q61K-AML- NRAS Q61K in AML — same as Q61R; no approved targeted agent.BMA-NRAS-Q61R-AML- NRAS mutations in AML (~10-15%) — adverse prognostic in some contexts; not directly targe...BMA-TP53-MUT-AML- TP53-mut AML — chemo-resistant, dismal outcomes (CR ~20% with 7+3, OS ~6 mo). Decitabine...BMA-TP53-R175H-AML- TP53 hotspot in AML — chemo-resistant pattern; venetoclax + HMA palliative; alloSCT prefe...BMA-TP53-R248Q-AML- TP53 hotspot in AML — chemo-resistant pattern; venetoclax + HMA palliative; alloSCT prefe...BMA-TP53-R273H-AML- TP53 hotspot in AML — chemo-resistant pattern; venetoclax + HMA palliative; alloSCT prefe...BMA-TP53-R282W-AML- TP53 hotspot in AML — chemo-resistant pattern; venetoclax + HMA palliative; alloSCT prefe...
Показання
IND-AML-1L-7-3- IND-AML-1L-7-3IND-AML-1L-7-3-GO-CBF- IND-AML-1L-7-3-GO-CBFIND-AML-1L-CPX351-SECONDARY- IND-AML-1L-CPX351-SECONDARYIND-AML-1L-QUIZARTINIB-FLT3ITD- IND-AML-1L-QUIZARTINIB-FLT3ITDIND-AML-1L-VEN-AZA- IND-AML-1L-VEN-AZAIND-AML-2L-GILTERITINIB-FLT3- IND-AML-2L-GILTERITINIB-FLT3IND-AML-2L-IDH2-ENASIDENIB- IND-AML-2L-IDH2-ENASIDENIBIND-AML-2L-KMT2A-REVUMENIB- IND-AML-2L-KMT2A-REVUMENIBIND-AML-CR1-ORAL-AZA-MAINTENANCE- IND-AML-CR1-ORAL-AZA-MAINTENANCEIND-AML-PEDIATRIC-AAML1031- IND-AML-PEDIATRIC-AAML1031IND-AML-RR-IDH1-OLUTASIDENIB- IND-AML-RR-IDH1-OLUTASIDENIBIND-ASCT-SECONDARY-MDS-AML-PREVENTION-OBSERVATION- IND-ASCT-SECONDARY-MDS-AML-PREVENTION-OBSERVATIONIND-ASCT-SECONDARY-MDS-AML-PREVENTION-SURVEILLANCE- IND-ASCT-SECONDARY-MDS-AML-PREVENTION-SURVEILLANCEIND-CEBPA-CARRIER-INTENSIFIED- IND-CEBPA-CARRIER-INTENSIFIEDIND-CEBPA-CARRIER-SURVEILLANCE- IND-CEBPA-CARRIER-SURVEILLANCEIND-EMERG-CINV-HIGH-EMETOGENIC- IND-EMERG-CINV-HIGH-EMETOGENICIND-EMERG-FEBRILE-NEUTROPENIA-EMPIRICAL- IND-EMERG-FEBRILE-NEUTROPENIA-EMPIRICALIND-EMERG-NEUTROPENIC-FEVER-PROPHYLAXIS- IND-EMERG-NEUTROPENIC-FEVER-PROPHYLAXISIND-EMERG-TLS-PROPHYLAXIS-RASBURICASE- IND-EMERG-TLS-PROPHYLAXIS-RASBURICASEIND-IATROGENIC-ALKYLATOR-TAML-PREVENTION-OBSERVATION- IND-IATROGENIC-ALKYLATOR-TAML-PREVENTION-OBSERVATIONIND-IATROGENIC-ALKYLATOR-TAML-PREVENTION-SURVEILLANCE- IND-IATROGENIC-ALKYLATOR-TAML-PREVENTION-SURVEILLANCEIND-IATROGENIC-ANTHRACYCLINE-CARDIO-PREVENTION-OBSERVATION- IND-IATROGENIC-ANTHRACYCLINE-CARDIO-PREVENTION-OBSERVATIONIND-IATROGENIC-ANTHRACYCLINE-CARDIO-PREVENTION-SURVEILLANCE- IND-IATROGENIC-ANTHRACYCLINE-CARDIO-PREVENTION-SURVEILLANCEIND-IATROGENIC-ANTHRACYCLINE-LATE-CARDIO-PREVENTION-OBSERVATION- IND-IATROGENIC-ANTHRACYCLINE-LATE-CARDIO-PREVENTION-OBSERVATIONIND-IATROGENIC-ANTHRACYCLINE-LATE-CARDIO-PREVENTION-SURVEILLANCE- IND-IATROGENIC-ANTHRACYCLINE-LATE-CARDIO-PREVENTION-SURVEILLANCEIND-IATROGENIC-PLATINUM-LATE-PREVENTION-OBSERVATION- IND-IATROGENIC-PLATINUM-LATE-PREVENTION-OBSERVATIONIND-IATROGENIC-PLATINUM-LATE-PREVENTION-SURVEILLANCE- IND-IATROGENIC-PLATINUM-LATE-PREVENTION-SURVEILLANCEIND-IATROGENIC-TOPO2-TAML-PREVENTION-OBSERVATION- IND-IATROGENIC-TOPO2-TAML-PREVENTION-OBSERVATIONIND-IATROGENIC-TOPO2-TAML-PREVENTION-SURVEILLANCE- IND-IATROGENIC-TOPO2-TAML-PREVENTION-SURVEILLANCEIND-MPN-SECONDARY-LEUKEMIA-PREVENTION-OBSERVATION- IND-MPN-SECONDARY-LEUKEMIA-PREVENTION-OBSERVATIONIND-MPN-SECONDARY-LEUKEMIA-PREVENTION-SURVEILLANCE- IND-MPN-SECONDARY-LEUKEMIA-PREVENTION-SURVEILLANCEIND-OCC-BENZENE-PREVENTION-INTENSIFIED-SURVEILLANCE- IND-OCC-BENZENE-PREVENTION-INTENSIFIED-SURVEILLANCEIND-OCC-BENZENE-PREVENTION-OBSERVATION- IND-OCC-BENZENE-PREVENTION-OBSERVATIONIND-OCC-FORMALDEHYDE-PREVENTION-INTENSIFIED-SURVEILLANCE- IND-OCC-FORMALDEHYDE-PREVENTION-INTENSIFIED-SURVEILLANCEIND-OCC-FORMALDEHYDE-PREVENTION-OBSERVATION- IND-OCC-FORMALDEHYDE-PREVENTION-OBSERVATIONIND-OCC-IONIZING-RADIATION-PREVENTION-INTENSIFIED-SURVEILLANCE- IND-OCC-IONIZING-RADIATION-PREVENTION-INTENSIFIED-SURVEILLANCEIND-OCC-IONIZING-RADIATION-PREVENTION-OBSERVATION- IND-OCC-IONIZING-RADIATION-PREVENTION-OBSERVATIONIND-RUNX1-CARRIER-INTENSIFIED- IND-RUNX1-CARRIER-INTENSIFIEDIND-RUNX1-CARRIER-SURVEILLANCE- IND-RUNX1-CARRIER-SURVEILLANCE
Тривожна ознака
RF-AML-CD33-POS-GO-CANDIDATE- CD33 expression on myeloblasts in newly-diagnosed AML (favorable / intermediate cytogenet...RF-AML-CORE-BINDING-FACTOR-FAVORABLE- AML with core-binding-factor (CBF) cytogenetics: t(8;21)(q22;q22.1) with RUNX1::RUNX1T1 f...RF-AML-EMERGENCY-TLS-LEUKOSTASIS- AML emergency triad: hyperleukocytosis (WBC ≥100 K/μL), tumor lysis syndrome (LDH >2× ULN...RF-AML-FLT3-ACTIONABLE- AML with FLT3-ITD or FLT3-TKD mutation — addition of midostaurin (or gilteritinib in r/r)...RF-AML-FRAILTY-AGE- AML patient frail or elderly unfit for intensive induction: age ≥75, OR age ≥65 with ≥2 c...RF-AML-HIGH-RISK-BIOLOGY- AML with adverse-risk biology per ELN 2022: TP53 mutation, complex / monosomal karyotype,...RF-AML-IDH1-MUT-ACTIONABLE- IDH1 R132 (R132H/C/G/L/S) activating mutation in AML — ~6-10% prevalence. Ivosidenib (AGI...RF-AML-IDH2-MUT-ACTIONABLE- IDH2 R140Q or R172K activating mutation in AML — ~8-12% prevalence. Enasidenib (IDHIFA /...RF-AML-INFECTION-SCREENING- AML patient with positive HBV / HCV / HIV serology, latent TB, or active uncontrolled inf...RF-AML-KMT2A-ACTIONABLE- KMT2A rearrangement (MLL fusion at 11q23) in AML — ~5-10% prevalence in adult AML; ELN-20...RF-AML-MEASURABLE-RESIDUAL-DISEASE- AML with detectable measurable residual disease (MRD) after induction or consolidation —...RF-AML-NPM1-MUT-FAVORABLE- NPM1 mutation (most commonly type-A: c.860_863dupTCTG / p.W288fs) in AML — ~30% of adult...RF-AML-ORGAN-DYSFUNCTION- AML patient with organ dysfunction precluding intensive 7+3 induction: ECOG ≥3, baseline...RF-AML-SECONDARY-AML-MRC-CPX351-ELIGIBLE- AML eligible for CPX-351 (Vyxeos) liposomal cytarabine+daunorubicin per the FDA-approved...RF-AML-TP53-ADVERSE- TP53-mutated AML — ELN-2022 adverse-risk classifier and WHO 5th- edition entity. ~10-15%...RF-AML-TRANSFORMATION-PROGRESSION- AML refractory or relapsed: <5% blast clearance after induction, or relapse after CR (ear...RF-ANKRD26-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in ANKRD26 (Thrombocytopenia 2,...RF-CASCADE-LFS-FDR-POSITIVE- A first-degree relative of the patient (parent, sibling, or child) has a documented posit...RF-CEBPA-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in CEBPA — most commonly an N-t...RF-DDX41-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in DDX41 — most commonly the p....RF-ETV6-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in ETV6 (Thrombocytopenia 5, TH...RF-IATROGENIC-ALKYLATOR-TAML-PREVENTION- History of prior cumulative alkylating-agent chemotherapy exposure (cyclophosphamide, ifo...RF-IATROGENIC-ANTHRACYCLINE-CARDIO-PREVENTION- History of cumulative anthracycline exposure ≥250 mg/m² (doxorubicin equivalent) — typica...RF-IATROGENIC-ANTHRACYCLINE-LATE-CARDIO-PREVENTION- Cancer survivor ≥5 years post-completion of curative-intent oncology treatment that inclu...RF-IATROGENIC-ASCT-SECONDARY-MDS-AML-PREVENTION- History of autologous stem-cell transplantation (ASCT) as consolidation or salvage therap...RF-IATROGENIC-PLATINUM-LATE-PREVENTION- Cancer survivor with prior cumulative platinum exposure ≥400 mg/m² (cisplatin) or AUC-equ...RF-IATROGENIC-PRIOR-RADIATION-PREVENTION- History of therapeutic radiation exposure ≥5 years ago to a body region — most commonly m...RF-IATROGENIC-TOPO2-TAML-PREVENTION- History of prior topoisomerase-II inhibitor exposure — etoposide, teniposide, anthracycli...RF-LI-FRAUMENI-CONFIRMED-CARRIER- Patient has a confirmed germline TP53 pathogenic variant (positive germline test, distinc...RF-LI-FRAUMENI-FAMILY-HISTORY-SUSPICION- Family pedigree or personal history meeting criteria suggestive of Li-Fraumeni Syndrome (...RF-LIFESTYLE-TOBACCO-CANCER-PREVENTION- Active tobacco smoking (current smoker OR cessation <15 years) OR smokeless tobacco use O...RF-MPN-SECONDARY-LEUKEMIA-PREVENTION- Myeloproliferative neoplasm (polycythemia vera [PV], essential thrombocythemia [ET], or p...RF-OCC-BENZENE-MALIGNANCY-PREVENTION- Documented historical occupational exposure to benzene in an individual without a current...RF-OCC-FORMALDEHYDE-PREVENTION- Documented historical occupational exposure to formaldehyde (gaseous HCHO and aqueous for...RF-OCC-IONIZING-RADIATION-PREVENTION- Documented historical occupational exposure to ionizing radiation — typical high-risk occ...RF-OCC-PAINTERS-PREVENTION- Documented historical occupational exposure as a painter — typical high-risk roles includ...RF-RUNX1-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in RUNX1 (Familial Platelet Dis...
Хвороба
DIS-APL- Acute Promyelocytic Leukemia (PML-RARA)DIS-ET- Essential ThrombocythemiaDIS-JMML- Juvenile myelomonocytic leukemia (JMML)DIS-MDS-HR- Myelodysplastic Syndromes — Higher-Risk (IPSS-R high / very high; includes MDS-EB)DIS-MDS-LR- Myelodysplastic Syndromes — Lower-Risk (IPSS-R very low / low / intermediate)DIS-PMF- Primary Myelofibrosis (DIPSS-Plus stratified)DIS-PV- Polycythemia Vera