American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the standard treatment for non-acute promyelocytic leukemia (non-APL AML)?

1. A 5-day course of chemotherapy

2. A 7-day course of cytarabine and a 3-day course of an anthracycline

3. Combination of cytarabine and only supportive care

4. Single-agent therapy with a novel targeted drug

The correct answer is: A 7-day course of cytarabine and a 3-day course of an anthracycline

The standard treatment for non-acute promyelocytic leukemia (non-APL AML) involves a combination regimen that typically includes cytarabine along with an anthracycline. This approach is well-established based on clinical trials that have shown improved outcomes in terms of response rates and overall survival when utilizing this chemotherapeutic strategy. In this regimen, cytarabine is administered for a total of seven days and is combined with an anthracycline, such as daunorubicin or idarubicin, given over three days. The rationale for this combination lies in the synergistic effect of both drugs: cytarabine acts to inhibit DNA synthesis and repair, while anthracyclines intercalate into DNA and inhibit topoisomerase II activity, leading to enhanced cytotoxicity against malignant cells. The combination of these drugs is preferred for patients with non-APL AML because it addresses the aggressive nature of the disease and significantly improves the chances of achieving a complete remission compared to other treatment options. This is crucial for setting the stage for long-term management and potential curative strategies like stem cell transplantation for patients who achieve remission. Other options either lack the necessary components to effectively treat non-APL AML or do not align with