Treatment for relapsed acute myeloid leukemia:  what is new?
OBJECTIVE
Despite enormous progress in the understanding of leukemia pathophysiology and novel transplantation protocols, the prognosis following acute myeloid leukemia (AML) relapse is still uniformly poor. In the current review, advances in risk stratification, protocols involving novel agents and allogeneic stem cell transplantation (ASCT) will be discussed in light of the vision of personalized therapy.


RESULTS
The role of ASCT in relapsed/refractory AML is well established and has been recently confirmed as mandatory for cure. Retrospective observations of different large cohorts categorized patients with early relapse, poor cytogenetics or fms-like tyrosine kinase receptor-3 internal tandem duplication mutation as the most challenging population. Multiple novel agents have been studied with various promising results; however, these agents can only serve as a bridge to transplantation. If ASCT is not an option, therapy should focus on prolongation of patient's life at its best possible quality. Accumulated molecular data open new horizons for personalizing therapy and assigning each patient to the drug or protocol from which the patient will benefit most.


CONCLUSIONS
Relapsed/refractory AML is a heterogeneous disease and no uniform protocol will provide cure to all patients. Molecular tests may contribute to future personalizing therapy resulting in improved outcome. Meanwhile, novel and more effective induction and postremission protocols are warranted to lower the relapse rate.
Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center, Haifa, Israel. y_ofran@rambam.health.gov.il
Yishai
Y
Ofran
Jacob M
JM
Rowe
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D018570:Risk Assessment; D019172:Transplantation Conditioning
D000970:Antineoplastic Agents; D004791:Enzyme Inhibitors