Acute myeloid leukaemia: lines of therapy
14 standard-of-care settings across 8 lines and 8 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | Fit | FLT3 | IDH | NPM1 | Risk group | TP53 / del(17p) | Unfit / older |
|---|---|---|---|---|---|---|---|---|
| Screening, prevention and diagnosis | 1 | · | · | · | · | · | · | · |
| Early / localised | · | · | · | · | · | 1 | · | · |
| Advanced, first line | · | 1 | 1 | · | · | · | 1 | · |
| Maintenance | 1 | · | · | · | · | · | · | · |
| Second line | 1 | 1 | · | · | · | · | · | · |
| Third line and beyond | · | · | 1 | 1 | 1 | · | · | · |
| Special situations | · | · | · | · | · | · | · | 2 |
| Other settings | 1 | · | · | · | · | · | · | · |
Screening, prevention and diagnosis
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Diagnosis and risk assignment | Marrow morphology, flow, karyotype/FISH, rapid FLT3/NPM1/IDH testing (results within days), NGS panel; ELN 2022 risk; fitness assessment. Menin-inhibitor and FLT3-inhibitor eligibility depends on these results. | NCCN · Category 2A | 66 |
Early / localised
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| Risk group | Fit, favourable or intermediate risk, CD33-positive | 7+3 plus fractionated gemtuzumab ozogamicin (ALFA-0701); high-dose cytarabine consolidation; MRD-guided transplant for intermediate risk. | NCCN · Category 2A | 86 |
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| Fit | Fit | 7+3 ± targeted agent; consolidation; allogeneic transplant by risk. | NCCN Guidelines: Acute Myeloid Leukemia | 93 | |
| FLT3 | Fit, FLT3-mutated | 7+3 plus midostaurin (ITD or TKD) or quizartinib (ITD only), consolidation with continued inhibitor, allogeneic transplant for most FLT3-ITD in CR1, post-transplant FLT3-inhibitor maintenance if MRD-positive. | NCCN · Category 1 (midostaurin, quizartinib)ESMO-MCBS · A (RATIFY) | 94 | |
| TP53 / del(17p) | Fit, adverse risk (TP53, complex karyotype, MDS-related) | Intensive induction or venetoclax-azacitidine to remission, then allogeneic transplant as the only realistic cure; clinical trial strongly preferred; TP53-mutated disease has no effective targeted therapy after the magrolimab and eprenetapopt failures. | NCCN · Category 2A (clinical trial preferred) | 89 |
Maintenance
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Maintenance after intensive therapy | Oral azacitidine (Onureg) for patients not transplanted (QUAZAR AML-001); FLT3 inhibitor maintenance after transplant in FLT3-ITD (MORPHO for MRD-positive); menin inhibitor maintenance in trials. | NCCN · Category 1 (oral azacitidine) | 89 |
Second line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Relapsed | Genotype-directed: gilteritinib, IDH inhibitors, menin inhibitors; transplant. | NCCN Guidelines: Acute Myeloid Leukemia | 68 | |
| Fit | Fit, secondary or therapy-related AML | CPX-351 induction (Study 301) then transplant in CR1; alternatives include 7+3 or venetoclax-based therapy in trials. | NCCN · Category 1 (age 60-75) | 82 |
Third line and beyond
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| FLT3 | Relapsed or refractory, FLT3-mutated | Gilteritinib monotherapy (ADMIRAL) or gilteritinib + venetoclax/azacitidine, then transplant; quizartinib in Japan. | NCCN · Category 1 | 93 | |
| IDH | Relapsed or refractory, IDH-mutated | Ivosidenib or olutasidenib (IDH1), enasidenib (IDH2), often with azacitidine or venetoclax; differentiation-syndrome monitoring. | NCCN · Category 2A | 89 | |
| NPM1 | Relapsed or refractory, NPM1-mutated or KMT2A-rearranged | Menin inhibitor: revumenib (KMT2Ar 2024; NPM1 2025) or ziftomenib (NPM1, November 2025), as a bridge to transplant; triplets with venetoclax-azacitidine in trials. | NCCN · Category 2A | 68 |
Special situations
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| Unfit / older | Unfit | Azacitidine + venetoclax. | NCCN Guidelines: Acute Myeloid Leukemia | 85 | |
| Unfit / older | Unfit for intensive chemotherapy (most patients over 75) | Venetoclax + azacitidine (VIALE-A) or venetoclax + oral decitabine-cedazuridine (ASCERTAIN-V, 2026); ivosidenib + azacitidine if IDH1-mutated (AGILE); low-dose cytarabine + venetoclax as an alternative. Continue until progression; consider transplant in responders who become fit. | NCCN · Category 1 (venetoclax + HMA)ESMO-MCBS · 4 (VIALE-A) | 93 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Acute promyelocytic leukaemia | ATRA + arsenic trioxide without chemotherapy for standard risk (cure >95%); ATRA + arsenic + idarubicin or gemtuzumab for high risk. Differentiation syndrome prophylaxis. | NCCN · Category 1 | — |
Regimens in the library
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.