Acute Myeloid Leukemia: Past, Present, and Prospects for the Future

Dose intensification of chemotherapy and the combination of a third cytotoxic agent with standard cytarabine and anthracycline-based induction chemotherapy have led to improved outcomes in select groups of patients with acute myeloid leukemia (AML). However, despite some progress in this area, it appears that we might be reaching the limit of cytotoxic chemotherapy for the treatment of AML, especially in older patients and in those with poor-risk features whose disease tends to be relatively chemoresistant. Recent advances in the molecular classification of AML have identified pathogenic pathways that can be exploited with targeted agents and rational drug combinations. Novel nontransplant immunotherapies also show promise in the treatment of AML, especially when a targetable molecular aberration cannot be identified. Sensitive methods for detecting minimal residual disease in AML have not only improved prognostication of these patients but also provide the framework for risk-adapted strategies in this heterogeneous disease.