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Diagnostik und Therapie der akuten myeloischen Leukämie

Die Neufassung der Onkopedia-Leitlinie 2018
  • C. RölligEmail author
CME-Topic
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Zusammenfassung

Im April 2018 ist die Neuauflage der Onkopedia-Leitlinie zur akuten myeloischen Leukämie (AML) als Aktualisierung von Vorversionen aus den Jahren 2010 und 2017 erschienen. Zwei wesentliche positive Entwicklungen auf dem Gebiet dieser immer noch schwer zu behandelnden Erkrankung machten die Überarbeitung erforderlich: erstens neue Erkenntnisse zu Risikostratifizierung und Monitoring und zweitens die Entwicklung und Zulassung neuer Therapeutika. Die modifizierte genetische Risikoklassifikation erlaubt eine bessere Trennung verschiedener prognostischer Gruppen und damit eine passgenauere Postremissionstherapie. Zusätzlich kann die genetische Typisierung durch die zunehmende Verfügbarkeit zielgerichteter Substanzen erstmalig auch therapeutische Weichen stellen. Mehrere innerhalb des vergangenen Jahres neu zugelassene Substanzen erweitern nun das Behandlungsspektrum bei der AML und geben Anlass zur Hoffnung, in der Zukunft einen größeren Teil der Patienten heilen zu können.

Schlüsselwörter

Zielgerichtete Therapie Risikostratifizierung Midostaurin Gemtuzumab CPX-351 

Abkürzungen

abnl()

Anomalie

Allo SZT

allogene Stammzelltransplantation

ASXL1

additional sex combs-like 1 gene

ATO

Arsen-Trioxid

ATRA

All-trans-Retinsäure

BSC

bestmögliche unterstützende (supportive) Behandlungsmaßnahmen (best supportive care)

CBF

Core-binding Factor Gene

CEBPA

CCAAT/enhancer-binding protein alpha Gen

CR

komplette Remission

del()

Deletion

DLI

Infusion von Spenderlymphozyten (donor lymphocyte infusion)

DNMT3A

DNA-Methyltransferase 3A Gen

ECOG

Aktivitätsstatus nach der Eastern Co-operative Oncology Group (ECOG)

EF

Ejektionsfraktion

FAB

Klassifikation der AML French-American-British

FLT3

FMS-artige (fms like) Tyrosinkinase 3 Gen

FLT3-ITD

Mutation des FLT3-Gens: internal tandem duplication

FLT3-TKD

Mutation des FLT3-Gens: tyrosine kinase domain

GO

Gemtuzumab Ozogamicin

HDAC

hochdosiertes Cytarabin

HMA

Hypomethylierende Substanzen

IDH 1/2

Isocitrat-Dehydrogenase 1/2 Gen

inv()

Inversion

LDAC

niedrigdosiertes Cytarabin

MRD

Minimale (messbare) Resterkrankung (disease)

NPM1

Nucleophosmin 1 Gen

PML-RARA

promyelocytic leukemia/retinoic acid receptor alpha Gen

RUNX1

Runt-related transcription factor 1 Gen

t()

Translokation

TP53

TP53-Tumorsuppressorgen

−x

Verlust

Diagnosis and treatment of acute myeloid leukemia

The updated 2018 Onkopedia Guideline

Abstract

In April 2018, an updated version of the previously published guidelines on acute myeloid leukemia (AML) from 2010 and 2017 was released. A revision was necessary because of two positive aspects: First, new data and insights on risk stratification and monitoring, and second, the clinical development and approval of new agents. The modified genetic risk classification allows a more precise distinction of different diagnostic groups and consequently a better matched post-remission treatment. The availability of new targeted drugs such as inhibitors turns genetic analyses from a mere prognostic tool into an instrument for treatment decisions. Several recently approved agents expand the treatment options for AML and raise hope for an improved prognosis and cure in the future.

Keywords

Molecular targeted therapy Risk, stratification Midostaurin Gemtuzumab CPX-351 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

Gemäß den Richtlinien des Springer Medizin Verlags werden Autoren und Wissenschaftliche Leitung im Rahmen der Manuskripterstellung und Manuskriptfreigabe aufgefordert, eine vollständige Erklärung zu ihren finanziellen und nichtfinanziellen Interessen abzugeben.

Autoren

C. Röllig: A. Finanzielle Interessen: Finanzielle Unterstützung klinischer Studien durch: AbbVie, Bayer, Celgene, Janssen, Novartis, Pfizer – Referenten- und Beratungshonorare von: AbbVie, Amgen, Astellas, BMS, Daiichy Sankyo, Janssen, Jazz, Novartis, Pfizer, Roche – B. Nichtfinanzielle Interessen: Angestellter Internist Universitätsklinikum Dresden | Mitgliedschaften: DGHO, Netzwerk EBM.

Wissenschaftliche Leitung

Die vollständige Erklärung zum Interessenkonflikt der Wissenschaftlichen Leitung finden Sie am Kurs der zertifizierten Fortbildung auf www.springermedizin.de/cme.

Der Verlag erklärt, dass für die Publikation dieser CME-Fortbildung keine Sponsorengelder an den Verlag fließen.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Medizinische Klinik und Poliklinik IUniversitätsklinikum TU DresdenDresdenDeutschland

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