Induction Therapy in Acute Myeloid Leukemia

This chapter covers acute myeloid leukemia (AML) induction therapy and the factors that can affect treatment and prognosis. Multiple randomized trials have attempted to improve response rates and survival using newer agents and variations in doses. Outside of academic centers, the "standard" induction therapy for AML has been described as a combination of 7 days of cytarabine (ara-C) at a dose of 100-200mg/m2/d with an anthracycline (daunorubicin or idarubicin) during days 1-3; this is typically referred to as the 7 + 3 regimen. Both antibacterial and antifungal prophylaxis has been studied and shown to reduce infections and improve outcomes in neutropenic patients treated for leukemia. Despite advances in understanding the biology of AML, there have been few changes in the treatment strategies used for the majority of patients. Also, despite several decades of research into AML treatment, only one new drug has been approved by the US Food and Drug Administration (FDA) for the treatment of AML. In May 2000, the FDA granted accelerated approval to gemtuzumab ozogamicin (GO) for the treatment of older patients (older than age 60) with AML in first relapse who were not candidates for standard therapy.