Leukemia acute myelogenous

Thioguanine is used primarily as part of induction chemotherapy regimens for acute myelogenous leukemia (AML). 

Cytarabine is used in the chemotherapy of acute myelogenous leukemia, usually in combination with anthracyclines, thioguanine, or both. It is less useful in acute lymphoblastic leukemia and lymphomas and has marginal activity against other tumors. Myelosuppres-sion is a major toxicity, as is severe bone marrow hypoplasia nausea and mucositis may also occur. 

A detailed study of the 0-linked oligosaccharides present on the surface of normal granulocytes, chronic myelogenous leukemia cells, and acute myelogenous leukemia cells has been completed. Structures were elucidated by f.a.b.-m.s. after permethylation, and methylation analysis before and after specific exo-glycosidase treatments. Some of the components were shown by f.a.b.-m.s. to be poly(N-acetyllactosaminyl) oligosaccharides, for example, 29. 

Acute myelogenous leukemia has been observed in 0.07% of MS patients treated with mitoxantrone.46 This form of acute leukemia appears within 2 to 4 years of initiating mitoxantrone and is generally responsive to standard antileukemic therapy. 

Topotecan inhibits topoisomerase I to cause single-strand breaks in DNA. The pharmacokinetics of topotecan can be described by a two-compartment model, with a terminal half-life of 80 to 180 minutes, with renal clearance accounting for approximately 70% of the clearance.19 Topotecan has shown clinical activity in the treatment of ovarian and lung cancer, myelodysplastic syndromes, and acute myelogenous leukemia. The intravenous infusion may be daily for 5 days or once weekly. Side effects include myelosuppression, mucositis, and diarrhea. 

The oncologist prescribes the normal doses of idarubicin 12 mg/m2 IV daily for 3 days and cytarabine 100 mg/m2 per day by continuous infusion for 7 days to treat her acute myelogenous leukemia. Her baseline laboratory measurements are significant for an elevated WBC count, a creatinine concentration of 2.5 mg/dL (221 pmol/L), and a bilirubin level of 1.6 mg/dL (27 pmol/L). 

Acute leukemias are classified according to their cell of origin. Acute lymphocytic leukemia (ALL) arises from the lymphoid line. Acute nonlymphocytic leukemia (ANLL) or acute myelogenous leukemia (AML) arises from the myeloid line. 

The current induction therapy for acute myelogenous leukemia (AML) usually consists of a combination of cytara-bine and daunorubicin, with the frequent addition of a steroid and/or an antimetabolite such as 6-thioguanine. The risk of infection is so high during this period that patients receive antibiotic and fungal prophylaxis. 

For all newly diagnosed patients with leukemia, an aspirate of the liquid marrow and a bone marrow core biopsy are obtained.5 Morphologic and cytochemical analysis of these samples distinguishes three subtypes of ALL (LI, L2, and L3) and eight subtypes of AML (M0-M7) as classified by the French-American-British (FAB) scheme. See Tables 92-2 and 92-3 for the FAB classification of acute myelogenous leukemia and acute lymphocytic leukemia. 

TABLE 92-2. Morphologic (FAB) Classification of Acute Myelogenous Leukemia... 

AS is a 65-year-old woman with relapsed acute myelogenous leukemia. PMH is significant for type II diabetes and renal insufficiency (CrCI 20 mL/minute). She is day +1 from a nonmyeloablative HCT with fludarabine (30 mg/m2 per day IV for 3 days) and total-body irradiation preparative regimen and a graft from a full HLA-matched sibling. 

Prophylaxis and treatment of hyperuricemia associated with tumor lysis syndrome. ALL, acute lymphoblastic leukemia AML, acute myelogenous leukemia IV, intravenous. (Data from refs. 32 and 33.)... 

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