[Current therapeutic strategies in the management of acute myeloid leukemia].
Acute myeloid leukemia (AML) is a rare disease of the hematopoietic stem cell leading to uncontrolled proliferation of immature progenitor cells. This results in a replacement of healthy hematopoiesis and in pancytopenia with corresponding symptoms (anemia, thrombo- and granulocytopenia). Diagnosis can reliably be confirmed by bone marrow aspiration, which also allows risk stratification by cytogenetic and molecular analysis. Therapy of AML that should preferentially be performed in clinical studies comprises induction therapy for achievement of complete cytomorphological remission (CR) and postremission strategies consisting of consolidation and maintenance therapy for eradication of residual blasts. The backbone of polychemotherapy is cytarabine and anthracyclines. Different regimens exist that achieve CR rates of 60-80%. As a consequence, pancytopenias up to 6 weeks will be experienced, that will lead to specific problems such as infections by atypical pathogens. To date, induction therapy will be performed independently of the individual risk constellation (with the exception of acute promyelocytic leukemia); however, postremission therapy is highly dependent on individual risk stratification. Besides conventional strategies, allogeneic stem cell transplantation has to be considered in certain risk groups depending on the availability of a matched donor. Taken together, cure can be achieved in about 40% of patients, however, with large interindividual variability.
Fiegl
Michael
M
Medizinische Klinik und Poliklinik III, Klinikum der Universität München-Grosshadern.
Hiddemann
Wolfgang
W
Braess
Jan
J
D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001707:Biopsy, Needle; D001853:Bone Marrow / Q000473:pathology; D016465:Bone Marrow Purging; D016026:Bone Marrow Transplantation; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D012074:Remission Induction; D019233:Retreatment
D018943:Anthracyclines; D003561:Cytarabine