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How do you approach therapy for a fit adult with relapsed AML with CNS involvement after allogeneic stem cell transplantation?
Is Ommaya placement with CNS-directed therapy preferred to intrathecal or cranial irradiation? How do you interweave this therapy with systemic therapy such as high dose Ara-C?
Answer from: at Community Practice
Agree with Dr. @Ann Mohrbacher. If on immunosuppression, would stop immunosuppression. HIDAC q12 hours x 5-6 days reinduction is a regimen that can be used for relapsed AML. There is some data in adding venetoclax to chemo induction and should be considered.If starting venetoclax single agent to add...
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Answer from: at Academic Institution
I would use intrathecal Cytarabine for immediate control, then a high dose AraC based regimen. Ultimately, prognosis is very poor, but consideration of research protocols could be discussed, or Car_T protocols if CNS disease is controlled eventually.