title: Frontline treatment of acute myeloid leukemia in adults.
abstract: Recent years have highlighted significant progress in understanding the underlying genetic and epigenetic signatures of acute myeloid leukemia(AML). Most importantly, novel chemotherapy and targeted strategies have led to improved outcomes in selected genetic subsets. AML is a remarkably heterogeneous disease, and individualized therapies for disease-specific characteristics (considering patients' age, cytogenetics, and mutations) could yield better outcomes. Compared with the historical 5-to 10-year survival rate of 10%, the survival of patients who undergo modern treatment approaches reaches up to 40-50%, and for specific subsets, the improvements are even more dramatic; for example, in acute promyelocytic leukemia, the use of all-trans retinoic acid and arsenic trioxide improved survival from 30 to 40% up to 80 to 90%. Similar progress has been documented in core-binding-factor-AML, with an increase in survival from 30% to 80% upon the use of high-dose cytarabine/fludarabine/granulocyte colony-stimulating factor combination regimens. AML treatment was also recently influenced by the discovery of the superiority of regimens with higher dose Ara-C and nucleoside analogues compared with the "7+3"regimen, with about a 20% improvement in overall survival. Despite these significant differences, most centers continue to use the "7+3" regimen, and greater awareness will improve the outcome. The discovery of targetable molecular abnormalities and recent studies of targeted therapies (gemtuzumab ozagomycin, FLT3 inhibitors, isocitrate dehydrogenase inhibitors, and epigenetic therapies), future use of checkpoint inhibitors and other immune therapies such as chimeric antigen receptor T-cells, and maintenance strategies based on the minimal residual disease evaluation represent novel, exciting clinical leads aimed to improve AML outcomes in the near future.
authors.affiliation: University of Texas MD Anderson Cancer Center, Department of Leukemia, 1515 Holcombe Blvd, 77030, Houston, TX, USA; Yerevan State Medical University, Department of Oncology, 114 Muratsan St., 0075, Yerevan, Armenia. Electronic address: gevorgtamamyan@gmail.com.
authors.forename: Gevorg
authors.initials: G
authors.lastname: Tamamyan
authors.affiliation: University of Texas MD Anderson Cancer Center, Department of Leukemia, 1515 Holcombe Blvd, 77030, Houston, TX, USA.
authors.forename: Tapan
authors.initials: T
authors.lastname: Kadia
authors.affiliation: University of Texas MD Anderson Cancer Center, Department of Leukemia, 1515 Holcombe Blvd, 77030, Houston, TX, USA.
authors.forename: Farhad
authors.initials: F
authors.lastname: Ravandi
authors.affiliation: University of Texas MD Anderson Cancer Center, Department of Leukemia, 1515 Holcombe Blvd, 77030, Houston, TX, USA.
authors.forename: Gautam
authors.initials: G
authors.lastname: Borthakur
authors.affiliation: University of Texas MD Anderson Cancer Center, Department of Leukemia, 1515 Holcombe Blvd, 77030, Houston, TX, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Cortes
authors.affiliation: University of Texas MD Anderson Cancer Center, Department of Leukemia, 1515 Holcombe Blvd, 77030, Houston, TX, USA.
authors.forename: Elias
authors.initials: E
authors.lastname: Jabbour
authors.affiliation: University of Texas MD Anderson Cancer Center, Department of Leukemia, 1515 Holcombe Blvd, 77030, Houston, TX, USA.
authors.forename: Naval
authors.initials: N
authors.lastname: Daver
authors.affiliation: University of Texas MD Anderson Cancer Center, Department of Leukemia, 1515 Holcombe Blvd, 77030, Houston, TX, USA.
authors.forename: Maro
authors.initials: M
authors.lastname: Ohanian
authors.affiliation: University of Texas MD Anderson Cancer Center, Department of Leukemia, 1515 Holcombe Blvd, 77030, Houston, TX, USA.
authors.forename: Hagop
authors.initials: H
authors.lastname: Kantarjian
authors.affiliation: University of Texas MD Anderson Cancer Center, Department of Leukemia, 1515 Holcombe Blvd, 77030, Houston, TX, USA.
authors.forename: Marina
authors.initials: M
authors.lastname: Konopleva
mesh_terms: D000328:Adult; D000818:Animals; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000188:drug therapy*; D011379:Prognosis; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents
keywords: Acute myeloid leukemia; Frontline treatment; High dose Ara-C; Nucleoside analogues