Treatment of acute myeloid leukemia under relapsed/refractory conditions or in older adults

Standard induction chemotherapy regimens achieve complete remission rates of 80% in younger adult patients with acute myeloid leukemia (AML). However, because of disease relapse only 40-50% of patients achieve long-term survival. Five-year survival rates in older patients are only one third of those achieved in younger cases. The adverse prognostic impact of advanced age is attributable to the chemotherapy-resistant nature of the blasts and the limited tolerability these patients have for intensive chemotherapy. For younger patients with relapsed/refractory AML, the therapeutic approach to curing AML is the re-induction of complete remission employing intensive chemotherapy, followed by allogeneic hematopoietic cell transplantation. If this approach is not feasible, less intensive chemotherapy or best supportive care or transplantation without disease remission may be performed. Older patients are unlikely to be candidates for hematopoietic cell transplantation in general. Older patients with newly diagnosed AML of low risk may be treated with intensive chemotherapy, while those with intermediate/high risks may have options including less intensive chemotherapy and best supportive care.