Induction therapy in acute myeloid leukemia: intensifying and targeting the approach

Acute myeloid leukemia (AML) is a heterogeneous group of clonal disorders which is treated with similar regimens despite the heterogeneity. The treatment approach for many years has used combination chemotherapy, with usually an anthracycline and cytarabine as the foundation. In the present review we will present new data from recently completed trials that have demonstrated advances in the treatment of AML.

We will discuss the recent trials that support the importance of dose intensification in younger patients either through increasing dose of the anthracycline, adding other agents such as gemtuzumab ozogamicin, or through 'timed sequential' therapy. We will promote the importance of treating the older AML patient (>60 years old) and the various ways different groups are addressing a different biologically behaving disease and the patient being treated. These methods include dose reduction, dose intensification and new agents with a better toxicity profile.

Due to aggressive induction therapy, patients with AML are having better remission and survival outcomes. New agents that are targeted to specific molecular abnormalities in the AML cell are being studied as additions to induction therapy.