Therapeutic Options in the Management of Acute Myelogenous Leukemia in Adults.
BACKGROUND: The treatment of acute myelogenous leukemia has evolved in recent years due to advances in supportive care, the identification of prognostic factors, and the careful evaluation of chemotherapeutic modalities in randomized clinical trials. METHODS: The classification and prognostic features are reviewed, and the results from clinical trials have been evaluated with an emphasis on randomized trials and on both remission induction and postremission phases of management. RESULTS: The combination of an anthracycline and standard-dose Ara-C form the basis of remission induction. High-dose Ara-C has greater toxicity. For postremission therapy, high-dose Ara-C improves results in those with good risk features or normal cytogenetics. Acute promyelocytic leukemia management includes all-trans-retinoic acid. CONCLUSIONS: Once a patient relapses from a nontransplant approach, high-dose therapy and allogeneic marrow transplantation are considered. Autologous stem cell transplantation cures some patients who do not have a donor.
Saez
RA
Bone Marrow Transplant Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA.