The treatment of adult acute myeloid leukemia

Induction therapy of acute myeloid leukemia (AML) with standard-dose chemotherapy will result in 52% to 72% of patients achieving a complete remission (CR) on bone marrow morphology. Newer agents that appear to improve the outcome of induction therapy are 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 postremission therapy is required after standard induction to maintain remission. However, new intensified postremission therapies have significantly improved outcome in de novo AML. 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. In the future, it is likely that new treatment strategies will be defined by identifying new prognostic subgroups. To identify new successful induction treatments in AML, more precise measures of CR are required including an attempt to define cytogenetic CR and molecular CR wherever it can be applied. A theoretical model of blast cell kill would suggest that remission duration may be a useful clinical end point to study the influence of new induction therapies on residual resistant leukemia.