[Expanding possibilities, strategic considerations, and novel methods in the diagnosis and chemotherapy of adult acute myeloid leukemia].
The WHO classification of adultory acute myeloid leukemia puts the main emphasis on prognosis, based mainly upon cytogenetic findings and gene-expression profiles. The complex prognostic assessment provides a more solid basis for early therapeutic stratification. This review focuses mainly on medical therapy. Induction phase is quite uniform, it consists of antracyclin and cytosin arabinosid. High-dose cytosin arabinosid is the predominant tool of postinduction therapy, especially in the favorable cytogenetic pattern cases. All-trans retinoic acid resulted in extremely good results in the promyelocytic cases, and this therapy seems to be advantageous in respect of acute DIC, too. Arsenic trioxide could be the drug of choice in relapsed promyelocytic leukemia. Some new agents are promising in refractory or relapsed cases, i.e. antibodies (Mylotarg) or farnesyltransferase inhibitors. The near future may bring about new therapeutic approaches, involving immunotherapy (dendritic cell vaccines) or gene-therapy as well.
Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, II. Belgyógyászati Klinika, Haematológia Tanszék.
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D000328:Adult; D018943:Anthracyclines / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D019008:Drug Resistance, Neoplasm; D020869:Gene Expression Profiling; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000188:drug therapy*; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis / Q000188:drug therapy; D020411:Oligonucleotide Array Sequence Analysis; D010087:Oxides / Q000008:administration & dosage; D010166:Palliative Care; D011379:Prognosis; D012074:Remission Induction / Q000379:methods; D014212:Tretinoin / Q000008:administration & dosage
D018943:Anthracyclines; D000911:Antibodies, Monoclonal; D001152:Arsenicals; D010087:Oxides; D003561:Cytarabine; D014212:Tretinoin; D000077237:Arsenic Trioxide