HIGH-DOSE THERAPY IN ACUTE-LEUKEMIA

The use of intensive induction chemotherapy, primarily with combinatio ns of an anthracycline and cytarabine, allows complete remission rates of greater than 70% in patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). However, with currently available standard-dose therapy, only 20% of young adults are cured. In order t o substantially increase the cure rate, adequate post-remission therap eutic strategies are mandatory. Three different therapeutic options ar e currently available: (i) dose-intensified chemotherapy; (ii) allogen eic stem cell transplantation; (iii) autologous stem cell transplantat ion. These therapeutic options should be carefully evaluated according to prognostic information, including cytogenetic and molecular abnorm alities as well as phenotypic characterization. Randomized trials of i ntensive postremission therapy have now confirmed improved leukemia-fr ee survival with the use of allogeneic or autologous transplantation. Autologous transplantation appears to be the most promising treatment modality in AML. Improved preparative regimens and purging techniques may be critical factors in determining the effectiveness of autologous transplantation in AML patients. In adult ALL, the role and optimal m ethods of stem cell transplantation are still under investigation.