Evolving treatment strategies in patients with high-risk acute myeloid leukemia

Acute myeloid leukemia (AML) is defined by a set of biologically distinct diseases characterized by maturation arrest and clonal proliferation of myeloid cells. Recommendations for post-remission therapy depend on assessing the leukemia risk characteristics, such as cytogenetics and molecular features present at diagnosis. Patients with high-risk disease include those whose leukemia is characterized by monosomal karyotype or poor-risk cytogenetic or molecular abnormalities, patients with antecedent hematologic disorders or therapy-related AML, and presence of adverse host factors, such as comorbidities, impaired performance status or older age. Older patients are more likely to have these adverse features. High-risk AML responds poorly to available induction treatment and is likely to relapse despite consolidation therapy. Current data support an increasing understanding of prognosis but have not yet resulted in effective therapies for patients with high-risk disease. This review discusses current therapies and evolving treatment strategies for high-risk AML.