NEW TRENDS IN THE TREATMENT OF ADULT ACUTE MYELOID-LEUKEMIA

During the past 20 years, the EORTC Leukaemia Cooperative Group has pe rformed four large randomised clinical trials in patients with acute m yeloblastic leukaemia (AML) who were under the age of 60 years. Result s of these studies support the use of intensive remission induction sc hedules. Although consolidation therapy with high-dose or standard-dos e chemotherapy did not improve longterm survival substantially, marked improvements were noted in patients receiving autologous or allogenei c bone marrow transplantation (BMT), especially in those aged 45 years or younger. Preliminary results of study AML-10, in which patients ar e receiving stem cell transplantation after a very intensive induction course and a single high-dose consolidation regimen, are especially e ncouraging. Improvements in the results of remission induction can be achieved by optimising the use of existing antileukaemic agents, decre asing the number of fatal complications, administering new chemotherap eutic or immunostimulatory agents, and making use of early allogeneic stem cell transplantation. Improved consolidation may be achieved by r epeated administration of high-dose chemotherapy or by autologous BMT or transplantation with autologous peripheral blood stem cells. Preven tion of relapse following BMT may be enhanced by the administration of immunomodulatory agents, such as interleukin-2 or linomide. Better de finition of prognostic groups in AML may make possible the recruitment of more homogeneous patient populations for clinical trials and facil itate the development of individualised treatment regimens that will b e associated with increased long-term survival. To encourage advanced research in leukaemia, the EORTC and the Italian Leukaemia Group (GIME MA) are now establishing a network of molecular and cytogenetic labora tories throughout Western Europe. (C) 1997 Published by Elsevier Scien ce Ltd.