Treatment of acute myeloid leukaemia in younger patients

The survival of AML in younger patients has improved in the last 20 years, as a consequence of a more intensive approach to treatment. Seventy-five to eighty percent of patients will enter complete remission, so the main challenge is to prevent relapse. Several trials have assessed the value of allogeneic or autologous transplantation. When these trials have been assessed by careful statistical methods, the advantage of transplant overall is difficult to detect. Intensive consolidation can deliver a similar survival, of which high-dose Ara-C has been widely adopted, but other intensive schedules appear equivalent. It is not known how many treatment courses are required. Patients are at differing risks of relapse which may influence the choice of treatment. In trials where a risk profile is available, and where a donor versus no-donor analysis is performed, there appears to be little robust evidence to support transplant in good or poor risk disease, although the experience in the latter groups is not unanimous. Standard risk patients may be the subgroup who deliver survival benefit, but since chemotherapy continues to improve, there remains some uncertainty. It is possible that technical improvements in transplantation, such as peripheral blood as a source of stem cells, may remove this uncertainty.