Ivosidenib is an IDH1 inhibitor used to treat relapsed/refractory acute myeloid leukemia (AML) patients carrying IDH1 mutations. The duration of medication needs to be personalized according to the disease status, treatment response, and tolerance. It is usually used continuously until disease progression or intolerable toxicity occurs, with no fixed medication month limit.

1. Standard treatment plan

(1) Initial dose: Take 500mg orally once a day for 28 consecutive days as one treatment cycle.

(2) Maintenance therapy: If the patient tolerates well and there is no disease progression, the treatment plan can be continued indefinitely.

Adjustment factors for 2 treatment courses

(1) Efficacy evaluation: Regular evaluation of treatment response through bone marrow puncture and hematological examination is required. For those who have achieved complete remission, it is recommended to continue medication for at least 6 months.

(2) Adverse reaction management: In case of grade 3 or above toxicity such as QT interval prolongation, medication should be temporarily suspended. After recovery, the dosage may be reduced to 250mg and treatment may be restarted daily.

3 Indications for discontinuation of medication

(1) Disease progression: including recurrence confirmed by hematological or bone marrow examination.

(2) Intolerable toxicity: life-threatening complications such as differentiation syndrome, Guillain Barr é syndrome, etc.

4 Considerations for Special Groups

(1) Liver injury patients: Mild injury does not require adjustment, moderate to severe injury should be reduced to 250mg per day.

(2) Elderly patients: Age does not affect the duration of medication, but it is necessary to strengthen electrocardiogram monitoring of QT interval changes.