第八章 : AML 治療地圖的五個核心

AML 是需要迅速處理、但也愈來愈能精準治療的疾病。2026 年的臨床決策不再只問「能不能做化療」，而是同時考量疾病基因、體能、病人目標、MRD 深度、移植與新藥。

• 確診初期：先排除 APL、處理感染／出血／腫瘤溶解，並快速取得 FLT3、NPM1、IDH1／2 與關鍵融合基因。

• 誘導後：以骨髓與 MRD 確認反應，不要只看周邊血球。

• 緩解後：依 ELN＋MRD 選擇鞏固、維持或異體移植。

• 復發時：重新分子檢測並優先考慮臨床試驗；可治療突變與藥物選擇可能和初診不同。

病人與家屬的任務不是背下所有療程，而是知道何時發出警訊、如何核對治療目標，以及在每個節點提出關鍵問題。

附錄 A 常用名詞解釋

就診前一頁式問題清單

• 我的疾病類型、ELN 風險與關鍵基因是什麼？

• 本次療程的目標是 CR、MRD 陰性、橋接移植，或症狀控制？

• 何時做下一次骨髓與 MRD？使用哪一種方法？

• 發燒、出血、腹瀉、便祕、口腔炎或呼吸困難要打哪支電話？

• 哪些藥物、保健品、食物或疫苗必須避免？

附錄 B 重要參考資料（AMA 格式）

1. Pollyea DA, Altman JK, Assi R, et al. NCCN Guidelines® Insights: Acute Myeloid Leukemia, Version 3.2026. J Natl Compr Canc Netw. 2026;24(6):222-229. doi:10.6004/jnccn.2026.0028

2. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Acute Myeloid Leukemia. Version 3.2026. Accessed July 2026.

3. Döhner H, Wei AH, Appelbaum FR, et al. Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN. Blood. 2022;140(12):1345-1377. doi:10.1182/blood.2022016867

4. National Cancer Institute. Acute Myeloid Leukemia Treatment (PDQ®)–Patient Version. Updated May 16, 2025.

5. DiNardo CD, Jonas BA, Pullarkat V, et al. Azacitidine and venetoclax in previously untreated acute myeloid leukemia. N Engl J Med. 2020;383(7):617-629. doi:10.1056/NEJMoa2012971

6. Pratz KW, Jonas BA, Pullarkat V, et al. Long-term follow-up of VIALE-A: venetoclax and azacitidine in chemotherapy-ineligible untreated acute myeloid leukemia. Am J Hematol. 2024.

7. Montesinos P, Recher C, Vives S, et al. Ivosidenib and azacitidine in IDH1-mutated acute myeloid leukemia. N Engl J Med. 2022;386(16):1519-1531. doi:10.1056/NEJMoa2117344

8. Stone RM, Mandrekar SJ, Sanford BL, et al. Midostaurin plus chemotherapy for acute myeloid leukemia with a FLT3 mutation. N Engl J Med. 2017;377(5):454-464. doi:10.1056/NEJMoa1614359

9. Erba HP, Montesinos P, Kim HJ, et al. Quizartinib plus chemotherapy in patients with newly diagnosed FLT3-ITD-positive acute myeloid leukaemia (QuANTUM-First). Lancet. 2023;401(10388):1571-1583.

10. Wei AH, Döhner H, Pocock C, et al. Oral azacitidine maintenance therapy for acute myeloid leukemia in first remission. N Engl J Med. 2020;383(26):2526-2537. doi:10.1056/NEJMoa2004444

11. Lancet JE, Uy GL, Cortes JE, et al. CPX-351 versus 7+3 cytarabine and daunorubicin chemotherapy in older adults with newly diagnosed high-risk or secondary acute myeloid leukemia. J Clin Oncol. 2018;36(26):2684-2692.

12. Lo-Coco F, Avvisati G, Vignetti M, et al. Retinoic acid and arsenic trioxide for acute promyelocytic leukemia. N Engl J Med. 2013;369(2):111-121. doi:10.1056/NEJMoa1300874

13. Perl AE, Martinelli G, Cortes JE, et al. Gilteritinib or chemotherapy for relapsed or refractory FLT3-mutated AML. N Engl J Med. 2019;381(18):1728-1740. doi:10.1056/NEJMoa1902688

14. US Food and Drug Administration. FDA approves revumenib for relapsed or refractory acute myeloid leukemia with a susceptible NPM1 mutation. October 24, 2025.

15. US Food and Drug Administration. FDA approves ziftomenib for relapsed or refractory acute myeloid leukemia with an NPM1 mutation. November 13, 2025.