Table 1. Therapeutic strategies in AML... | American Society of Hematology

Table 1.

Therapeutic strategies in AML and relapsed or refractory AML

Strategy	Comments
AML
Induction
Daunorubicin 45-60 mg/m² for 3 days or alternative anthracycline or the anthracenedione mitoxantrone with cytarabine 100 mg/m² for 7 days	Optimal dose of anthracycline is unknown.
	No definitive evidence that any anthracycline or the anthracenedione mitoxantrone is better at any age.
	Standard regimen is effective in all cytogenetic subtypes.
	No evidence that addition of high-dose cytarabine (HiDAC) or etoposide is essential.
	The induction regimen should not be attenuated for older adults.
After remission*
HiDAC 1-3 g/m² over 1-3 hours for 3-6 days × 1-4 cycles	Optimal dose, schedule, and number of cycles of HiDAC are unknown.
	Although HiDAC is clearly effective, groups using different intensive regimens have reported similar data.
Maintenance therapy	Standard of care in acute promyelocytic leukemia (APL); role in other subtypes is less convincing.
Stem-cell transplantation	Most potent antileukemic strategy, but caution is warranted in interpretation of studies that are underpowered and often not applicable to current practice.
Relapsed or refractory AML
Chemotherapy	Rarely curative in any subtype.
Effective reduction in leukemia-cell burden	Essential for cure.
	High-dose cytarabine is most effective.
	No evidence that additional drugs are beneficial.
	May be effective even if prior exposure to cytarabine in induction or consolidation.
	Best if first CR is long (more than 6-12 months).
	Investigational approach is appropriate if short CR1 or refractory.
Allogeneic transplantation	Potentially curative.
	Best results if in second CR or in early first relapse.
Autologous transplantation	Few reports of cure.
	Best results if in second CR with previously harvested stem cells.
Palliative care	Appropriate for older adults not eligible for curative approaches.

Strategy	Comments
AML
Induction
Daunorubicin 45-60 mg/m² for 3 days or alternative anthracycline or the anthracenedione mitoxantrone with cytarabine 100 mg/m² for 7 days	Optimal dose of anthracycline is unknown.
	No definitive evidence that any anthracycline or the anthracenedione mitoxantrone is better at any age.
	Standard regimen is effective in all cytogenetic subtypes.
	No evidence that addition of high-dose cytarabine (HiDAC) or etoposide is essential.
	The induction regimen should not be attenuated for older adults.
After remission*
HiDAC 1-3 g/m² over 1-3 hours for 3-6 days × 1-4 cycles	Optimal dose, schedule, and number of cycles of HiDAC are unknown.
	Although HiDAC is clearly effective, groups using different intensive regimens have reported similar data.
Maintenance therapy	Standard of care in acute promyelocytic leukemia (APL); role in other subtypes is less convincing.
Stem-cell transplantation	Most potent antileukemic strategy, but caution is warranted in interpretation of studies that are underpowered and often not applicable to current practice.
Relapsed or refractory AML
Chemotherapy	Rarely curative in any subtype.
Effective reduction in leukemia-cell burden	Essential for cure.
	High-dose cytarabine is most effective.
	No evidence that additional drugs are beneficial.
	May be effective even if prior exposure to cytarabine in induction or consolidation.
	Best if first CR is long (more than 6-12 months).
	Investigational approach is appropriate if short CR1 or refractory.
Allogeneic transplantation	Potentially curative.
	Best results if in second CR or in early first relapse.
Autologous transplantation	Few reports of cure.
	Best results if in second CR with previously harvested stem cells.
Palliative care	Appropriate for older adults not eligible for curative approaches.

Essential for curing AML and clearly benefiting younger adults (those younger than 55-60 years old).

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