Induction and postremission strategies in acute myeloid leukemia: what is new?
OBJECTIVE
Induction followed by postremission therapy is recognized as the main road toward cure in acute myeloid leukemia (AML). Induction approach has not changed substantially for many years. Despite identifying numerous heterogeneous factors in AML, bench-derived insights are sluggishly translated into clinical protocols. In the current review, advances in intensified dose induction protocols, risk stratification, and disease monitoring are presented. Some promising as well as disappointing agents used for tailoring and targeting therapies in AML are also discussed.


RESULTS
Intensifying anthracycline dose in young AML patients was recently shown to improve induction results. Importantly, maximal doses in induction have been shown to be safe also in older adults, negating a common perception that too often led to attenuation of induction therapy in this population. Novel targeted agents and the explosive number of newly identified prognostic factors or disease-specific biomarkers are promoting AML therapy toward a more personalized future.


CONCLUSIONS
Survival of AML patients is constantly improving. High doses of 'old drugs' for chemotherapy induction, followed by a postremission combination of chemotherapy and novel targeted agents may hold the key for cure. Disease-specific molecular abnormalities may play a role in monitoring and guiding therapy.
Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center, Israel. y_ofran@rambam.health.gov.il
Yishai
Y
Ofran
Jacob M
JM
Rowe
D000208:Acute Disease; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007951:Leukemia, Myeloid / Q000628:therapy*; D012074:Remission Induction; D014184:Transplantation, Homologous