AML ELN Favourable or Intermediate Risk — When First Induction (7+3) Does Not Achieve Remission

Clinical scenario

This protocol addresses patients with acute myeloid leukaemia classified as ELN favourable or intermediate risk, and specifically those who do not have core binding factor AML, therapy-related AML, AML with myelodysplasia-related changes, FLT3-ITD/TKD positivity, or ELN adverse-risk features.

Previous treatment & failure condition

First induction with cytarabine plus daunorubicin (7+3) — with or without the addition of gemtuzumab ozogamicin considered in eligible younger CD33-positive non-CBF-AML patients — did not achieve complete remission or CR with incomplete count recovery (CR/CRi, defined as <5% blasts in the bone marrow) when assessed between day 14 and day 21. Persistent blasts at that point are the trigger for escalation to this second induction step.

Treatment goal

Achievement of CR/CRi — fewer than 5% blasts in the bone marrow — enabling progression to consolidation treatment.

Approach (partial overview)

A second induction cycle is indicated. The regimen may replicate the first induction chemotherapy or take a different path involving intermediate-dose cytarabine — the full selection criteria, alternative options, and supporting evidence are available in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

If none of the previous markers is positive, 7+3 induction ChT is generally recommended [II, A].

Patients with 5% blasts in BM after induction 1 (blast persistence) should receive a second induction cycle, which may consist of the identical ChT as induction 1 or of a regimen containing intermediate-dose cytarabine (IDAC), for example, FLAG-Ida [III, C].

As soon as patients achieve CR/CRi after 1 or 2 induction cycles, they should proceed to consolidation treatment [II, B].

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