Quick Reference | Differentiation Syndrome (DS): AML Therapy

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Quick Reference | Differentiation Syndrome (DS): AML Therapy

Acute Myeloid Leukemia

Key Takeaways | Challenging Cases in Cancer: Low-Risk MDS Program

Myelodysplastic Syndromes

Key Takeaways | Challenging Cases in Cancer: AML

Acute Myeloid Leukemia

HIGH-RISK PATIENTS – Patients on targeted AML therapy

Common Agents

1. IDH inhibitors: Ivosidenib, Enasidenib (14-19%)

1. Menin inhibitors: Revumenib, Ziftomenib (25%)

1. FLT3 inhibitors: Gilteritinib, Quizartinib (less common: 3-5%)

Diagnosis: 2 or more symptoms required
➢ 7 KEY DIAGNOSTIC CRITERIA & FREQUENCY OF SYMPTOMS

1. Dyspnea/Hypoxia	Shortness of breath, low O2 saturation (25.8%)
2. Pulmonary Infiltrates/Effusions	Imaging or clinical findings (22.6%)
3. Edema/Weight Gain	Peripheral edema, rapid weight gain (22.6%)
4. Fever	Unexplained temperature elevation (19.4%)
5. Acute Renal Failure	Rising creatinine (6.5%)
6. Unexplained Leukocytosis	WBC >10,000 cell/L (common)
7. Rash/Lymphadenopathy	More common with IDH inhibitors (3.2%)

Severity	Grading
Severe	2 signs/symptoms present
Moderate	3-4 signs/symptoms present
Severe	5 signs/symptoms present

Next steps upon confirmation of suspected DS

1. Notify oncology team immediately-patients needevaluation TODAY!

1. Consider preparing for admission-Many patients require hospitalization.

1. Anticipate dexamethasone order: IV or PO for a minimum of 3 days.

1. Do not stop targeted therapy without oncology consultation. Recommendationsfor holding vary on
  agent

Next steps upon confirmation of suspected DS

- When in doubt, escalate to the oncology team!

- Dyspnea is a common presenting symptom in AML, often attributable to anemia. A thorough medication review is essential to distinguish anemia-related symptoms from those associated with differentiation syndrome.

- A single sign or symptom is insufficient for diagnosis; assessment should focus on patterns of presentation.

- Prompt dexamethasone initiation is key to successful DS management.

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