Update in acute leukemia 2003: a risk adapted approach to acute myeloblastic leukemia in adults

Acute myeloblastic leukemia represents a heterogeneous group of diseases. The diagnosis and prognosis is most accurately provided by pretreatment assessment of the clonal molecular genetic derangement responsible for the disease, often provided by cytogenetic analysis. Other prognostic features include patient age, antecedent myelodysplasia, prior chemotherapy, and the presence of FLT-3 mutations. Accurate assessment of prognosis permits a risk-adapted treatment approach to maximize probability of cure and minimize treatment-related toxicity. The majority of patients with promyelocytic leukemia with the PML/RARalpha fusion gene can be cured with an all-trans-retinoic acid and anthracycline-based treatment program. All other patients are typically given cytarabine and anthracycline-containing induction regimens, although some with particularly poor prognosis disease may be more appropriate candidates for experimental induction therapies. Postinduction treatments include further conventional chemotherapy, stem cell transplant strategies, and experimental approaches. Issues pertinent in selecting treatments for patients in the different risk categories are reviewed.