Table 1 Select precautions and... | American Society of Hematology

Table 1

Select precautions and recommendation for AML therapy in patients with heart disease

	Specific supportive care considerations	Induction therapy	Postremission strategy
LVEF <45%^3,4	1. Minimize IV infusions	1. HiDAC or 7+3	1. Repeated HiDAC
LVEF <45%^3,4	2. Repeat LVEF evaluation prior to each chemotherapy cycle	2. If anthracycline used, consider epirubicin or mitoxantrone	2. RIC allo-SCT may be considered for high-risk AML
Ischemic heart disease^15,17	1. Aspirin + beta-blocker	1. If possible, postpone induction for few days	Based on leukemia risk stratification and LVEF
	2. Maintain hemoglobin >8 g/dL	2. Use HiDAC
		3. Avoid anthracycline
		4. Aspirin throughout induction
	1. PCI prior to induction if active ischemia despite maximal noninvasive therapy		If not performed prior to induction, PCI is indicated for pending coronary obstruction prior to chemotherapy
	2. Bare metal stent

	Specific supportive care considerations	Induction therapy	Postremission strategy
LVEF <45%^3,4	1. Minimize IV infusions	1. HiDAC or 7+3	1. Repeated HiDAC
LVEF <45%^3,4	2. Repeat LVEF evaluation prior to each chemotherapy cycle	2. If anthracycline used, consider epirubicin or mitoxantrone	2. RIC allo-SCT may be considered for high-risk AML
Ischemic heart disease^15,17	1. Aspirin + beta-blocker	1. If possible, postpone induction for few days	Based on leukemia risk stratification and LVEF
	2. Maintain hemoglobin >8 g/dL	2. Use HiDAC
		3. Avoid anthracycline
		4. Aspirin throughout induction
	1. PCI prior to induction if active ischemia despite maximal noninvasive therapy		If not performed prior to induction, PCI is indicated for pending coronary obstruction prior to chemotherapy
	2. Bare metal stent

allo-SCT, allogeneic stem cell transplantation.