Intensified Induction and Post-Remission Therapy for Acute Myeloid Leukaemia

Standard induction therapy of acute myeloid leukemia (AML) with standard dose chemotherapy will result in 52-72% of patients achieving a complete remission (CR) and only 20% long term survivors. Newer agents which intensify induction therapy appear to improve the outcome of induction include etoposide, idarubicin and high dose cytarabine. New studies are now required to define new induction combinations and the place of these and other promising new drugs in the treatment. Standard attenuated post-remission therapy is required after standard induction to maintain remission. However, new intensified post-remission therapies have significantly improved outcome in de novo patients. This development has required re-examination of the value of intensive treatment. There is now clear clinical evidence that a dose-response effect is present for cytarabine in AML. The optimal placement of intensified treatment and marrow transplantation requires further study.