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Evolent Level 1 Medical Oncology

Pathways and Low-Value Regimens

Acute Myeloid Leukemia (AML)

Regimen Options
Last Updated: 11/20/2024 See Details
Evolent Pathways Febrile Neutropenic Risk Emetogenic Risk References
INDUCTION
 

cytarabine and daunorubicin

High Moderate
 

cytarabine and idarubicin

High Moderate
 

daunorubicin and cytarabine, liposome *for pts who are suitable for intensive therapy and age ≥60 years; therapy related AML or AML from prior MDS*

High Moderate
 

azacitidine or decitabine and venetoclax *for patients that are not suitable for intensive therapy, e.g. unfit elderly patients*

High Moderate
 

cytarabine, daunorubicin and midostaurin *FLT3 mutation*

High Moderate
 

cytarabine, idarubicin and midostaurin *FLT3 mutation*

High Moderate
 

ivosidenib and azacitidine *IDH1 mutation positive*

Low Moderate
 

quizartinib and cytarabine and daunorubicin or idarubicin *FLT3-ITD mutation*

High Moderate
CONSOLIDATION
 

cytarabine and daunorubicin

High Moderate
 

cytarabine and idarubicin

Intermediate Moderate
 

daunorubicin and cytarabine, liposome *for pts who are suitable for intensive therapy and age ≥60 years; therapy related AML or AML from prior MDS*

High Moderate
 

HiDAC (high dose cytarabine)

Low Low
 

cytarabine and midostaurin *FLT3 mutation*

High Moderate
 

quizartinib and cytarabine *FLT3-ITD mutation*

High Moderate
MAINTENANCE
 

quizartinib *FLT3-ITD mutation* who previously received quizartinib and with no allogeneic HCT planned

High Moderate
RELAPSED/REFRACTORY
 

cytarabine and daunorubicin

High Moderate
 

cytarabine and idarubicin

High Moderate
 

fludarabine and cytarabine

High Moderate
 

fludarabine, cytarabine and idarubicin (FLAG-IDA)

High Moderate
 

ivosidenib *IDH-1 mutation positive*

Low Moderate
 

enasidenib *IDH-2 mutation positive*

Low Moderate
 

gilteritinib *FLT3 mutation positive*

Low Moderate
 

Best Supportive Care or Clinical Trial

Not Applicable Not applicable
INDUCTION
Evolent Pathways

cytarabine and daunorubicin

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
Evolent Pathways

cytarabine and idarubicin

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
Evolent Pathways

daunorubicin and cytarabine, liposome *for pts who are suitable for intensive therapy and age ≥60 years; therapy related AML or AML from prior MDS*

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
Evolent Pathways

azacitidine or decitabine and venetoclax *for patients that are not suitable for intensive therapy, e.g. unfit elderly patients*

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
Evolent Pathways

cytarabine, daunorubicin and midostaurin *FLT3 mutation*

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
Evolent Pathways

cytarabine, idarubicin and midostaurin *FLT3 mutation*

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
Evolent Pathways

ivosidenib and azacitidine *IDH1 mutation positive*

Febrile Neutropenic Risk
low
Emetogenic Risk
moderate
Evolent Pathways

quizartinib and cytarabine and daunorubicin or idarubicin *FLT3-ITD mutation*

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
CONSOLIDATION
Evolent Pathways

cytarabine and daunorubicin

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
Evolent Pathways

cytarabine and idarubicin

Febrile Neutropenic Risk
intermediate
Emetogenic Risk
moderate
Evolent Pathways

daunorubicin and cytarabine, liposome *for pts who are suitable for intensive therapy and age ≥60 years; therapy related AML or AML from prior MDS*

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
Evolent Pathways

HiDAC (high dose cytarabine)

Febrile Neutropenic Risk
low
Emetogenic Risk
low
Evolent Pathways

cytarabine and midostaurin *FLT3 mutation*

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
Evolent Pathways

quizartinib and cytarabine *FLT3-ITD mutation*

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
MAINTENANCE
Evolent Pathways

quizartinib *FLT3-ITD mutation* who previously received quizartinib and with no allogeneic HCT planned

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
RELAPSED/REFRACTORY
Evolent Pathways

cytarabine and daunorubicin

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
Evolent Pathways

cytarabine and idarubicin

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
Evolent Pathways

fludarabine and cytarabine

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
Evolent Pathways

fludarabine, cytarabine and idarubicin (FLAG-IDA)

Febrile Neutropenic Risk
high
Emetogenic Risk
moderate
Evolent Pathways

ivosidenib *IDH-1 mutation positive*

Febrile Neutropenic Risk
low
Emetogenic Risk
moderate
Evolent Pathways

enasidenib *IDH-2 mutation positive*

Febrile Neutropenic Risk
low
Emetogenic Risk
moderate
Evolent Pathways

gilteritinib *FLT3 mutation positive*

Febrile Neutropenic Risk
low
Emetogenic Risk
moderate
Evolent Pathways

Best Supportive Care or Clinical Trial

Febrile Neutropenic Risk
na
Emetogenic Risk
na
Regimen Alternative References
LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES

Induction

fludarabine and HiDAC and idarubicin and G-CSF and gemtuzumab ozogamicin

Alternative: cytarabine and daunorubicin/idarubicin

Induction

daunorubicin and cytarabine, liposome

Alternative: cytarabine and daunorubicin/idarubicin

Induction/consolidation

gemtuzumab ozogamicin

Alternative: cytarabine and daunorubicin/idarubicin

LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES

Induction

Regimen

fludarabine and HiDAC and idarubicin and G-CSF and gemtuzumab ozogamicin

Induction

Regimen

daunorubicin and cytarabine, liposome

Induction/consolidation

Regimen

gemtuzumab ozogamicin