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NCCN Flash Updates: NCCN Guidelines Updated for Acute Myeloid Leukemia

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), and the NCCN Drugs & Biologics Compendium (NCCN Compendium^®) for Acute Myeloid Leukemia. These NCCN Guidelines^® are currently available as Version 5.2023.

Link directly to the Updates section of the NCCN Guidelines: Acute Myeloid Leukemia

Global

• Terminologies in all NCCN Guidelines are being actively modified to advance the goals of equity, inclusion, and representation.
• References updated throughout the guideline.

AML-1

• Induction eligible, 2nd pathway, risk group modified: AML with FLT3-ITD/TKD mutation
• Induction eligible, 2nd pathway, treatment induction modified:
  • Standard 7+3 (daunorubicin or idarubicin) + midostaurin (FLT3-ITD or TKD)(category 1)
  • New regimen added: Standard 7 + 3 (daunorubicin or idarubicin) + quizartinib (FLT3-ITD only)(category 1)

AML-3

• 1st pathway, reinduction:
  • 2nd bullet modified: Standard 7 + 3 (daunorubicin or idarubicin)
  • 4th bullet modified: Standard 7 + 3 (daunorubicin or idarubicin) + midostaurin (BM aspirate and biopsy on day 21; FLT3-mutated [ITD or TKD])
  • New 5th bullet added: Standard 7 + 3 or 5 + 2 (daunorubicin or idarubicin) + quizartinib (FLT3-ITD only)
• 2nd pathway, reinduction:
  • 1st bullet modified: Standard 7 + 3 (daunorubicin or idarubicin)
  • 3rd bullet modified: Standard 7 + 3 (daunorubicin or idarubicin) + midostaurin (BM aspirate and biopsy on day 21; FLT3 mutated [ITD or TKD])
  • New 4th bullet added: Standard 7 + 3 or 5 + 2 (daunorubicin or idarubicin) + quizartinib (FLT3-ITD only)

AML-7

• 2nd pathway:
  • Risk group, 1st bullet modified: AML with FLT3-ITD/TKD mutation
  • Treatment (consolidation, age <60 y):
    • 2nd bullet modified: HiDAC + midostaurin (FLT3 mutated-ITD or TKD)
    • New 4th bullet added: HiDAC + quizartinib (FLT3-ITD only)

AML-8

• 2nd pathway:
  • Risk group modified: AML with FLT3-ITD/TKD mutation
  • Treatment (consolidation, age ≥60 y):
    • 1st bullet modified: Intermediate-dose cytarabine + midostaurin (FLT3-ITD or TKD)
    • New 2nd bullet added: Intermediate-dose cytarabine + quizartinib (FLT3-ITD only)

AML-8A

• Footnote removed: Alternate dosing of cytarabine for postremission therapy has been reported (see Discussion). Jaramillo S, et al. Blood Cancer J 2017;7:e564

AML-9

• 2nd pathway, maintenance therapy
  • Qualifier modified: Post allogeneic HCT, in remission, and history of FLT3-ITD mutation
  • FLT3 inhibitor maintenance treatment modified
    • 1st bullet modified: Sorafenib (FLT3-ITD or TKD)
    • 2nd bullet modified: Midostaurin (FLT3-ITD or TKD) (category 2B)
    • 3rd bullet modified: Gilteritinib (FLT3-ITD or TKD) (category 2B)
    • New 4th bullet added: Quizartinib (FLT3-ITD only) (category 2B)
• 3rd pathway, maintenance therapy added:
  • Qualifier added: Patient with history of FLT3-ITD mutation, previously received quizartinib, no allogeneic HCT is planned
  • FLT3 inhibitor maintenance treatment added: Quizartinib (FLT3-ITD only)
• 4th pathway modified: If none Neither of the above scenarios is applicable

AML-E 1 of 9

• Therapy column, 6th row modified: Standard 7+3 (daunorubicin or idarubicin) + midostaurin (FLT3-ITD or TKD) (Also for AML-E 3 of 9)
• Regimen column, 6th row modified: Standard-dose cytarabine 100-200 mg/m2 continuous infusion x 7 days with daunorubicin 60 mg/m2 or idarubicin 12 mg/m2 x 3 days and oral midostaurin 50 mg every 12 hours, days 8–21 (Also for AML-E 3 of 9)
• New row added for Standard 7 + 3 (daunorubicin or idarubicin) + quizartinib (FLT3-ITD only)

AML-E 3 of 9

• New row added for Standard 7 + 3 (daunorubicin or idarubicin) + quizartinib (FLT3-ITD only)
• New row added for 5 + 2 (daunorubicin or idarubicin) + quizartinib (FLT3-ITD only)

AML-E 7 of 9

• Consolidation Age <60 Years table
  • Therapy column, 3rd row modified: HiDAC + midostaurin (FLT3-ITD or TKD)
  • New row added for HiDAC + quizartinib (FLT3-ITD only)

AML-E 8 of 9

• Therapy column, 4th row modified: Intermediate-dose cytarabine + midostaurin (FLT3-ITD or TKD)
• New row added for Intermediate-dose cytarabine + quizartinib (FLT3-ITD only)

AML-E 9 of 9

• Therapy column, 4th, 5th, and 6th rows modified by adding (FLT3-ITD or TKD) to Sorafenib, Midostaurin, and Gilteritinib
• New row added for Quizartinib (FLT3-ITD only)
• Footnote f added: During cycle 1, quizartinib should be dosed at 26.5 mg PO once daily on days 1-14 if QTcF is ≤450 ms. If QTcF remains ≤450 ms on day 15, the dose should be increased to 53 mg PO daily for the remainder of the 28 day cycle. The 26.5 mg dose should be maintained if QTcF was >500 ms at any point during induction or consolidation.

AML-J

• Targeted therapy for AML with FLT3-ITD mutation, new 3rd bullet added: Quizartinib (category 2B)

 

Previous updates to the NCCN Guidelines for Acute Myeloid Leukemia can be found in the UPDATES section of the current version.

 

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), the NCCN Biomarkers Compendium^®, the NCCN Chemotherapy Order Templates (NCCN Templates^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients^®, please visit NCCN.org/patientguidelines.

Free NCCN Guidelines apps for iPhone, iPad, and Android devices are now available! Visit NCCN.org/apps.

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