Acute myeloid leukaemia

The EU has approved 15 indications of 8 drugs in acute myeloid leukaemia. 13 of them need a biomarker result: FLT3 (7), PML::RARA (4), CD33 (1) and IDH1/2 (1).

Subtype

Line of therapy

Approved indications, Acute myeloid leukaemia
DrugBiomarker requirementRegimenSettingConditions
CD33-positive1
+ daunorubicin and cytarabine
1L
Aged 15 years and above; de novo AML; except acute promyelocytic leukaemia (APL)
FLT3 mutation7
+ standard daunorubicin and cytarabine
Induction
Then maintenance monotherapy
Vanflyta
FLT3-ITD
+ standard cytarabine and anthracycline induction chemotherapy
Induction
Then maintenance monotherapy
Monotherapy
Maint.
After standard daunorubicin and cytarabine induction and high-dose cytarabine consolidation chemotherapy; Complete response
Vanflyta
FLT3-ITD
Monotherapy
Maint.
After quizartinib + standard cytarabine and anthracycline induction and standard cytarabine consolidation chemotherapy without progression
+ high-dose cytarabine
Consol.
After standard daunorubicin and cytarabine induction chemotherapy
Vanflyta
FLT3-ITD
+ standard cytarabine consolidation chemotherapy
Consol.
After quizartinib + standard cytarabine and anthracycline induction chemotherapy
Monotherapy
2L
Relapsed or refractory
IDH1 mutation1
Tibsovo
R132
+ azacitidine
1L
Not eligible to receive standard induction chemotherapy
PML::RARA fusion4
Defines the disease
+ all-trans-retinoic acid (ATRA)
Induction
Acute promyelocytic leukaemia only; Low-to-intermediate risk; white blood cell count ≤ 10 x 103/μl
t(15;17) translocation or PML/RAR-alpha gene
Monotherapy
Induction
Acute promyelocytic leukaemia only; After previous treatment should have included a retinoid and chemotherapy
Defines the disease
+ all-trans-retinoic acid (ATRA)
Consol.
Acute promyelocytic leukaemia only; Newly diagnosed; low-to-intermediate risk; white blood cell count ≤ 10 x 103/μl
t(15;17) translocation and/or PML/RAR-alpha gene
Monotherapy
Consol.
Acute promyelocytic leukaemia only; After previous treatment should have included a retinoid and chemotherapy; Relapsed/refractory
No biomarker required2
Daurismo
None
+ low-dose cytarabine
1L
Not candidates for standard induction chemotherapy
Venclyxto
None
+ a hypomethylating agent
1L
Ineligible for intensive chemotherapy

Biomarkers in acute myeloid leukaemia

Label wording15

The sentence from section 4.1 of the SmPC that each indication above comes from.

  1. Gemtuzumab ozogamicin (Mylotarg)
    MYLOTARG is indicated for combination therapy with daunorubicin (DNR) and cytarabine (AraC) for the treatment of patients aged 15 years and above with previously untreated, de novo CD33-positive acute myeloid leukaemia (AML), except acute promyelocytic leukaemia (APL) (see sections 4.4 and 5.1).
  2. Arsenic trioxide (Trisenox)
    Newly diagnosed low-to-intermediate risk acute promyelocytic leukaemia (APL) (white blood cell count, ≤ 10 x 103/μl) in combination with all-trans-retinoic acid (ATRA)
  3. Arsenic trioxide (Trisenox)
    Relapsed/refractory acute promyelocytic leukaemia (APL) (previous treatment should have included a retinoid and chemotherapy) characterised by the presence of the t(15;17) translocation and/or the presence of the promyelocytic leukaemia/retinoic-acid-receptor-alpha (PML/RAR-alpha) gene.
  4. Arsenic trioxide (Trisenox)
    TRISENOX is indicated for induction of remission, and consolidation in adult patients with: • Newly diagnosed low-to-intermediate risk acute promyelocytic leukaemia (APL) (white blood cell count, ≤ 10 x 103/μl) in combination with all-trans-retinoic acid (ATRA)
  5. Arsenic trioxide (Trisenox)
    TRISENOX is indicated for induction of remission, and consolidation in adult patients with: • Relapsed/refractory acute promyelocytic leukaemia (APL) (previous treatment should have included a retinoid and chemotherapy) characterised by the presence of the t(15;17) translocation and/or the presence of the promyelocytic leukaemia/retinoic-acid-receptor-alpha (PML/RAR-alpha) gene.
  6. Quizartinib (Vanflyta)
    VANFLYTA is indicated in combination with standard cytarabine and anthracycline induction and standard cytarabine consolidation chemotherapy, followed by VANFLYTA single-agent maintenance therapy for adult patients with newly diagnosed acute myeloid leukaemia (AML) that is FLT3-ITD positive.
  7. Quizartinib (Vanflyta)
    VANFLYTA is indicated in combination with standard cytarabine and anthracycline induction and standard cytarabine consolidation chemotherapy, followed by VANFLYTA single-agent maintenance therapy for adult patients with newly diagnosed acute myeloid leukaemia (AML) that is FLT3-ITD positive.
  8. Quizartinib (Vanflyta)
    VANFLYTA is indicated in combination with standard cytarabine and anthracycline induction and standard cytarabine consolidation chemotherapy, followed by VANFLYTA single-agent maintenance therapy for adult patients with newly diagnosed acute myeloid leukaemia (AML) that is FLT3-ITD positive.
  9. Venetoclax (Venclyxto)
    Venclyxto in combination with a hypomethylating agent is indicated for the treatment of adult patients with newly diagnosed acute myeloid leukaemia (AML) who are ineligible for intensive chemotherapy.
  10. Ivosidenib (Tibsovo)
    Tibsovo in combination with azacitidine is indicated for the treatment of adult patients with newly diagnosed acute myeloid leukaemia (AML) with an isocitrate dehydrogenase-1 (IDH1) R132 mutation who are not eligible to receive standard induction chemotherapy (see section 5.1).
  11. Gilteritinib (Xospata)
    Xospata is indicated as monotherapy for the treatment of adult patients who have relapsed or refractory acute myeloid leukaemia (AML) with a FLT3 mutation (see sections 4.2 and 5.1).
  12. Midostaurin (Rydapt)
    in combination with standard daunorubicin and cytarabine induction and high-dose cytarabine consolidation chemotherapy, and for patients in complete response followed by Rydapt single agent maintenance therapy, for adult patients with newly diagnosed acute myeloid leukaemia (AML) who are FLT3 mutation-positive (see section 4.2);
  13. Midostaurin (Rydapt)
    in combination with standard daunorubicin and cytarabine induction and high-dose cytarabine consolidation chemotherapy, and for patients in complete response followed by Rydapt single agent maintenance therapy, for adult patients with newly diagnosed acute myeloid leukaemia (AML) who are FLT3 mutation-positive (see section 4.2);
  14. Midostaurin (Rydapt)
    in combination with standard daunorubicin and cytarabine induction and high-dose cytarabine consolidation chemotherapy, and for patients in complete response followed by Rydapt single agent maintenance therapy, for adult patients with newly diagnosed acute myeloid leukaemia (AML) who are FLT3 mutation-positive (see section 4.2);
  15. Glasdegib (Daurismo)
    Daurismo is indicated, in combination with low-dose cytarabine, for the treatment of newly diagnosed de novo or secondary acute myeloid leukaemia (AML) in adult patients who are not candidates for standard induction chemotherapy.