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Favourable-Risk AML Post-Remission — RACP Adult Medicine MCQ

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ModerateHaematologyFavourable-Risk AML Post-RemissionRACP Adult Medicine

A 45-year-old woman with acute myeloid leukaemia achieves complete remission after induction chemotherapy (7+3 regimen). Cytogenetics show t(8;21) – a favourable-risk abnormality. What is the recommended post-remission strategy?

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Correct answer: D — Autologous stem cell transplant

For favourable-risk AML [t(8;21), inv(16)/t(16;16), mutated NPM1 without FLT3-ITD], consolidation with high-dose cytarabine (HiDAC) for 3–4 cycles is the standard post-remission strategy. Allogeneic SCT is NOT recommended in first remission for favourable-risk AML (reserved for relapse). The 5-year survival for favourable-risk AML with consolidation chemotherapy alone is 60–70%. Relapsed favourable-risk AML can be successfully treated with reinduction and then allogeneic SCT in second remission. MRD monitoring (by flow cytometry or molecular markers) guides surveillance.

Reference: eTG – 2025 – Haematology; NCCN – 2025 – AML Guidelines; ELN – 2022 – AML Recommendations