Treatment and prognostic factors in acute myeloid leukaemia

Current induction chemotherapy regimens afford a complete remission in 60 to 80% of patients less than 60 years of age who are diagnosed with acute myelogenous leukaemia. Patients who undergo consolidation with high dose Ara-C or with autologous or allogeneic bone marrow transplantation can expect a long-term disease free survival of 30 to 45%. Which mode of consolidation is preferable is still being investigated in randomized studies. Many disease characteristics have been put forward as prognostic variables in treatment outcome and as understanding of the biology of AML has continued to expand, cytogenetic and molecular markers have assumed greater importance in disease characterization, but the ultimate role that these play in prognosis remains incompletely defined. Once AML has relapsed, bone marrow transplantation may result in prolonged disease free survival as compared to use of salvage chemotherapy regimens. Because the long-term survival of all patients diagnosed with AML is only in the order of 10 to 20%, new treatment approaches to this disease are required. Current clinical and research efforts have focused on modulation of the immune system, modulation of drug resistance phenotypes, and understanding of the response of leukaemic cells to haematopoietic growth factors.