title: The prevalent predicament of relapsed acute myeloid leukemia.
abstract: A majority of patients with acute myeloid leukemia (AML) will relapse after achieving complete remission. At relapse, patients should be risk stratified and a decision made about the appropriateness of intensive therapy and whether a potentially curative allogeneic stem cell transplantation (allo-SCT) is possible. Risk factors include duration of first complete remission and adverse cytogenetics, as well as age and FLT3 mutation status. Available therapies are steadily increasing, but for the most part should be regarded as either best palliation or as a bridge to allo-SCT. Simple symptomatic therapies for patients with extreme age or the worst prognosis should also be considered. Newer therapeutic options include novel cytotoxic chemotherapies including clofarabine, immunomodulatory agents, targeted therapies against FLT3 and mTOR, and immunoconjugates. All patients with relapsed AML should be considered for an appropriate clinical trial.
authors.affiliation: Department of Clinical Haematology and BMT Service, The Royal Melbourne Hospital, Parkville, Australia. jeff.szer@mh.org.au
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Szer
mesh_terms: D000227:Adenine Nucleotides / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000617:Aminoglycosides / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001087:Arabinonucleosides / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D000077866:Clofarabine; D019175:DNA Methylation; D003657:Decision Making; D000079982:Gemtuzumab; D005998:Glycine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D006877:Hydroxamic Acids / Q000627:therapeutic use; D015470:Leukemia, Myeloid, Acute / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods; D033581:Stem Cell Transplantation; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors / Q000378:metabolism; D014184:Transplantation, Homologous / Q000379:methods; D051941:fms-Like Tyrosine Kinase 3 / Q000037:antagonists & inhibitors / Q000378:metabolism
chemical_list: D000227:Adenine Nucleotides; D000617:Aminoglycosides; D061067:Antibodies, Monoclonal, Humanized; D001087:Arabinonucleosides; D006877:Hydroxamic Acids; D000077866:Clofarabine; D000079982:Gemtuzumab; C546842:MTOR protein, human; C497970:FLT3 protein, human; D051941:fms-Like Tyrosine Kinase 3; D058570:TOR Serine-Threonine Kinases; C531970:tosedostat; D005998:Glycine