MANAGEMENT OF PRIMARY AND TREATMENT-RELAT ED ACUTE MYELOGENOUS LEUKEMIA

Modern treatment regimens achieve a full recovery in 40 to 50% of chil dren with acute myelogenous leukemia (AML), Age younger than adverse p rognostic significance. Remission rates range from 75 to 90% after ind uction therapy with one or two courses of cytarabine (7 days) and anth racycline (3 days). More aggressive induction regimens are probably mo re effective but carry a higher risk of fatal infection and can only b e used in specialized units. Consolidation/intensification therapy has a major influence on disease-free survival. Allogenic bone marrow tra nsplantation is the treatment of choice in patients with an HLA-compat ible sibling. Conditioning regimens that do not involve total body irr adiation are associated with milder posttransplantation sequelae. In n ontransplanted patients, high-dose cytarabine therapy during the inten sification phase is associated with better outcomes. Autologous bone m arrow transplantation yields results similar to those of aggressive in tensification chemotherapy. Maintenance treatment after the intensific ation phase has not been found to increase survival, and may even have the opposite effect. Prophylactic treatment to the CNS relies mainly on intrathecal chemotherapy, and brain radiation is necessary only in patients with meningeal involvement at diagnosis. Retinoic acid and ch emotherapy is the best treatment in promyelocytic leukemia. Interleuki n-2 therapy, drug resistance reversion, and use of molecular methods t o monitor minimal residual disease are approaches that carry hope for future improvements in the treatment of AML.