Treatment of resistant acute myeloid leukemia

Although combination cytotoxic chemotherapy induces complete remission in 60-80% of adults with previously untreated acute myeloid leukemia, most patients will ultimately relapse and die from leukemia. Strategies which have been developed for patients with relapsed leukemia include the use of active non-cross-resistant chemotherapeutic agents, allogeneic or autologous bone marrow transplantation, or combined sequential therapy with hematopoietic growth factors and chemotherapy. Most salvage chemotherapeutic regimens use high-dose cytarabine; other agents which have activity include idarubicin, mitoxantrone, etoposide, and high-dose cyclophosphamide. Bone marrow transplantation represents the preferred approach for patients with resistant leukemia offering a likelihood of prolonged disease-free survival. Unique combinations of high-dose chemotherapy and growth factors may provide an alternative therapeutic role in the treatment of resistant leukemia.