Adult myeloid leukaemias current and future treatments

Acute myeloid leukaemia Chemotherapy for AML is divided into two phases: induction and consolidation. The initial aim of induction treatment is to produce a “morphological complete remission” — ie, normal neutrophil and platelet counts and a reduction in the number of leukaemic blast cells to <5% of the total white blood cell count in the bone marrow. Induction regimens include cytarabine and an anthracycline (see Box 1, p123). Between 70% and 90% of patients achieve complete remission after one or two courses of induction treatment. Recent research suggests that adding the immunoconjugate gemtuzumab ozogamicin (a combination of an anti-CD33 monoclonal antibody and an anthracycline antibiotic known more commonly by its brand name Mylotarg) to regimens containing cytarabine and daunorubicin might increase response rate and lengthen disease-free survival. However, this treatment is not licensed in Europe at present (see “Future therapies” below). Patients designated as “good risk” according to cytogenetic profiling (see p121 of accompanying article) are normally treated with two courses of induction chemotherapy followed by one or two courses of consolidation chemotherapy. However, uncertainty remains as to the most effective consolidation schedule and the optimal number of courses. Patients designated as “intermediate risk” or “poor risk” according to their cytogenetic profile and who respond to induction chemotherapy can be considered for an allogeneic stem cell transplant (SCT; see p126). Chemotherapy alone is associated with a significant risk of disease relapse in these patient groups. The treatment of AML differs for certain patient populations.