Supportive Care in Acute Myeloid Leukemia

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Ruben A. Mesa, MD, FACP, moderates this discussion with Rafael Bejar, MD, PhD; Elias Jabbour, MD; and Rami Komrokji, MD. These experts in hematology and oncology discuss the pathways involved in leukemic transformation, risk-adjusted approaches to treatment, and supportive care in acute myeloid leukemia.

In this segment, Ruben A. Mesa, MD, FACP; Rami Komrokji, MD; and Elias Jabbour, MD, highlight essential supportive care strategies in acute myeloid leukemia (AML) treatment.

Patients with acute myeloid leukemia (AML) must be able to endure their therapy, states Ruben A. Mesa, MD, FACP. Patient outcomes are compromised if they are unable to tolerate what becomes a complicated course of treatment, says Mesa, making the application of supportive care practices highly important in the management of AML.

Complications of leukostasis, for example, may be encountered during the treatment of the AML subtype, acute promyelocytic leukemia (APL), precipitating the need for supportive care, such as leukapheresis, to control the white blood cell counts.

Episodes of bleeding may occur in patients suffering from disseminated intravascular coagulopathy (DIC) as well as those not in DIC, states Rami Komrokji, MD, citing the need for blood transfusions.

Patients may develop mucositis, making them vulnerable to infectious processes and febrile neutropenia. This makes infection prophylaxis key, notes Komrokji, whose institution utilizes triple coverage with antibacterial, antifungal, and antiviral agents. Empirically, practitioners should be very aggressive with anti-infective therapies, adds Elias Jabbour, MD, emphasizing the importance of initiating antibiotics before obtaining a positive culture. Many of the anti-infective agents may also cause QT prolongation, says Jabbour, which must be carefully monitored.


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