Table 2 Select precautions and... | American Society of Hematology

Table 2

Select precautions and recommendation for AML therapy in patients with renal or hepatic dysfunction

	Specific supportive care considerations	Induction therapy	Postremission strategy
Renal failure^27,29,32	1. Caution with fluid balance	1. “3+7” with regular cytarabine dose	1. Mitoxantrone + etoposide preferred
	2. Loop diuretics	2. Reduce daunorubicin by 50% if creatinine >3 mg/dL	2. Dose-adjusted HiDAC not recommended
	3. Avoid sodium bicarbonate
	4. Leukapheresis for TLS prevention
	5. Adjust allopurinol dose
Dialysis²⁷	Use dialysis to balance electrolytes and prevent TLS	“3+7” with reduced anthracycline dose: depending on anticipated prognosis from the renal disease	Repeat induction regimen
Hepatic cirrhosis^65,66	Careful monitoring for coagulopathy	Dose reduction based on bilirubin blood level
Hepatic cirrhosis^65,66	Careful monitoring for coagulopathy	If bilirubin >5 mg/dL, maximum cytarabine dose is 50 mg/m²

	Specific supportive care considerations	Induction therapy	Postremission strategy
Renal failure^27,29,32	1. Caution with fluid balance	1. “3+7” with regular cytarabine dose	1. Mitoxantrone + etoposide preferred
	2. Loop diuretics	2. Reduce daunorubicin by 50% if creatinine >3 mg/dL	2. Dose-adjusted HiDAC not recommended
	3. Avoid sodium bicarbonate
	4. Leukapheresis for TLS prevention
	5. Adjust allopurinol dose
Dialysis²⁷	Use dialysis to balance electrolytes and prevent TLS	“3+7” with reduced anthracycline dose: depending on anticipated prognosis from the renal disease	Repeat induction regimen
Hepatic cirrhosis^65,66	Careful monitoring for coagulopathy	Dose reduction based on bilirubin blood level
Hepatic cirrhosis^65,66	Careful monitoring for coagulopathy	If bilirubin >5 mg/dL, maximum cytarabine dose is 50 mg/m²

“3+7”, 3 days of daunorubicin and 7 days of cytarabine.