Consolidation treatment for core binding factor AML (RUNX1-RUNX1T1 or CBFB-MYH11-positive) after induction
Clinical Scenario
This protocol applies to acute myeloid leukemia with a core binding factor (CBF) molecular abnormality — specifically RUNX1-RUNX1T1 (t(8;21)) or CBFB-MYH11 (inv(16)/t(16;16)) positivity — in patients who are eligible for standard induction and consolidation chemotherapy.
Prior Treatment Step
Before consolidation, patients must have completed induction therapy. For those who required a second induction cycle — which may consist of an intermediate-dose cytarabine-containing regimen such as FLAG-Ida (fludarabine, cytarabine, granulocyte-colony stimulating factor, and idarubicin) — the required milestone is achievement of complete remission or complete remission with incomplete haematologic recovery (CR/CRi; less than 5% blasts in the bone marrow). This consolidation protocol is the next step once that remission threshold has been met.
Consolidation Approach (Partial Overview)
Post-remission consolidation for CBF-AML involves multiple cycles of cytarabine-based chemotherapy. In select cycles, a targeted antibody-drug conjugate may be considered for CD33-positive disease. An alternative consolidation strategy involving haematopoietic cell transplantation is also addressed in the full protocol. Cycle selection criteria, sequencing decisions, and eligibility guidance are available in the complete regimen.
References
- If CBF-AML patients are consolidated with ChT, 3 cycles with IDAC are recommended [II, B].
- In CBF-AML patients, the addition of 3 mg/m² GO given on day 1 in consolidation 1 and 2 is optional [II, C], as it remains unclear whether GO in consolidation contributes to the overall benefit.
- Patients in CR with ELN favourable-risk AML should be consolidated with ChT [I, A], while autoHCT is an alternative and results in better RFS, but not OS, than ChT (e.g. in patients with CBF-AML or double-mutant CEBPA AML) [II, B].