Acute myeloid leukemia in adults

The treatment outcome for most adults with acute myeloid leukemia (AML) remains unacceptable. Additional agents or substitution of high-dose cytarabine for conventional-dose cytarabine during induction does not improve the remission rate or overall survival. There is substantial toxicity with high-dose cytarabine during induction. Thus, induction therapy for newly diagnosed patients with AML should consist of cytarabine (100 mg/m(2) as a continuous intravenous infusion over 24 hours for 7 days) and daunorubicin, idarubicin, or mitoxantrone. Meta-analysis demonstrates a modest benefit for idarubicin. Most patients who achieve a remission should receive further therapy with two to four cycles of high-dose cytarabine. Allogeneic stem cell transplant is reserved for patients with poor risk features. There is no role for autologous stem cell transplant in first remission outside a clinical trial. The majority of adults relapse. Salvage therapy usually consists of high-dose cytarabine. Allogeneic or autologous stem cell transplantation is preferred in second or subsequent remission. Uncommon diseases such as AML, for which the outcome remains poor, should be treated on clinical trials whenever possible.