Treatment of Non-APL Acute Myeloid Leukemia with Diagnosed Central Nervous System Involvement

In a subset of patients with acute myeloid leukemia (non-APL), leukaemic cells infiltrate the central nervous system. When CNS involvement is confirmed at diagnosis, a specific treatment approach targeting the cerebrospinal fluid compartment is indicated alongside systemic management.

Clinical scenario

Acute myeloid leukaemia (non-APL) with diagnosed central nervous system involvement. This scenario applies to patients in whom CNS disease has been confirmed and who require directed intrathecal intervention.

Treatment goal

The primary clinical objective is clearance of blasts from the cerebrospinal fluid (CSF). Treatment continues until blast clearance is achieved and confirmed.

Treatment approach — partial overview

Management involves directed intrathecal chemotherapy administered at defined intervals. The full protocol specifies the agent, schedule, and the endpoint criteria for discontinuation. The complete regimen — including the exact schedule, number of doses, and criteria for treatment duration — is detailed in the structured protocol.

Full regimen details, including dosing schedule and stopping rules, are available via the protocol below.

Instant Access to Structured Evidence-Based Regimens

References

If central nervous system (CNS) involvement is diagnosed, the patient should be treated with intrathecal cytarabine twice weekly, with two injections beyond blast clearance from the cerebrospinal fluid (CSF), except in APL patients in whom intrathecal treatment should be delayed until recovery of coagulopathy.

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