Approaches to the therapy of relapsed acute myeloid leukemia

Managing patients with relapsed acute myeloid leukemia is a major clinical challenge. Although 60-70% of patients with AML achieve complete remission following induction therapy with cytarabine and an anthracycline, at least 70-80% of patients achieving remission eventually relapse. While there are few comparative trials that provide therapeutic guidelines, an initial decision as to treatment can be seen as a choice between reusing previously effective drugs or initiating new classes of drugs. Some of the newer agents which have definite activity include amsacrine, mitoxantrone, diaziquone, idarubicin, homoharringtonine, and carboplatin. Allogeneic, autologous, and syngeneic bone marrow transplantation probably represent the preferred approaches in suitable patients, either in early relapse or after second remission is achieved.