Acute myelogenous leukemia: New drug, new data, new decisions

Over the past decade, improvements in the therapy of acute myelogenous leukemia (AML) have focused on the use of new agents in the induction regimen and on intensifying post-remission therapy in an attempt to prolong the duration of complete remission. In induction, the major efforts have been in substituting newer anthracyclines and other agents for daunorubicin and in increasing the dose of cytosine arabinoside (Ara-C) or adding additional agents to induction such as etoposide. These alterations have not significantly improved the complete remission rate but appear to improve remission duration (Weick, et al, 1996; Bishop, et al, 1998). Whether high-dose Ara-C is optimally given in consolidation or in induction is not clear (Bishop, et al, 1998; Mayer, et al, 1994). The issue of intensifying induction therapy in AML has been recently reviewed (Rowe, Tallman, 1997). The focus of this discussion will be on a novel agent that is emerging for the treatment of AML in induction and on the results of the large intergroup trials in the United States and Europe addressing the role of allogeneic and autologous stem cell transplantation as post-remission therapy for AML. For a recent comprehensive overview on the biology and therapy of AML, the reader is referred to an education session at the American Society of Hematology meeting in Miami Beach, Florida, in December 1998 (Appelbaum, et al, 1998).