I have a 38 y/o F with favorable risk AML, biallelic CEBPA and RAD21 E148, normal karyotype, who I inherited post-induction (FLAG-IDA-VEN) from another institution due to insurance issues. Her induction course was complicated by bacteremia and acute cholecystitis, but she has recovered well and achieved a CR. I am planning HiDAC consolidation. Would you consider adding gemtuzumab even though she did not receive it with induction? Or just use HiDAC alone? And a related question, do you have much experience with HiDAC-123 vs HiDAC-135? Our institution has exclusively used the latter but are considering a change to improve bed availability/patient access.

AML Specialist

Great question. In general I would avoid GO if not given upfront. The benefit in CEBPA mutated patients is also not well established. I would also be concerned about giving GO in case she relapsed and needs transplant. We also use exclusively HIDAC 135 although have done daily HIDAC as outpatient in very select patients.