New induction and postinduction strategies in acute myeloid leukemia

Improving or replacing the traditional induction (3 + 7) and consolidation (high-dose cytarabine; Ara-C) as the standard of care for acute myeloid leukemia (AML) has proved disappointing.

Recent studies have raised the possibility that daunorubicin dose escalation might have the potential to improve survival. Antibody-directed therapy by means of gemtuzumab ozogamicin as an adjunct to induction chemotherapy may yet be a viable option in older patients, and alternative nucleoside analogues in induction could help higher risk subgroups. In consolidation, the number of courses and dose level of Ara-C required are being clarified. New treatments for older patients who will not be subjected to conventional chemotherapy are an active area, but randomized trials have not yet usurped low-dose Ara-C (LDAC).

Recent information in these areas is reviewed.