Progress and controversies in the treatment of pediatric acute myelogenous leukemia

The outcome for children and adolescents with acute myelogenous leukemia (AML) has substantially improved during the past several decades, such that nearly 50% of these patients can be cured. A significant part of this improvement has occurred over the past 10 years, during which time, dose intensification has played a much greater role in therapeutic strategies. Although dose intensification increased the cure rate for pediatric patients with AML, there has also been increased treatment-related morbidity and mortality. Further, despite such toxicity, the primary cause of death is still leukemia. This article outlines some of the different strategies leading to our current treatments and presents several questions and controversies. These questions lead to what future therapeutic options and approaches will be pursued.