Acute myeloid leukemia in adults: where do we go from here?

Although 30-40% of newly diagnosed younger patients with acute myeloid leuk emia (AML) can be cured with current approaches, the overall outcome has no t improved in recent years. In addition, the outcome in adults > 60 years o f age remains dismal with < 10% of patients achieving remission remaining a live and disease free. Results of randomized clinical trials in AML evaluat ing high-dose cytosine arabinoside, changes in anthracyclines, the use of h ematopoietic growth factors, stem cell transplantation in first remission, and modulation of the multidrug resistance phenotype are reviewed. New dire ctions for clinical trials include the use of nonmyeloablative allogeneic s tem cell transplantation as a form of "immunotherapy", refinements in autol ogous stem cell transplantation, and possibly manipulations of neoangiogene sis in the bone marrow and incorporation of newer agents, such as gemtuzuma b zogamicin into treatment regimens. It is likely, however, that future adv ances will be a consequence of a better understanding of the biology of leu kemic stem cells, and issues related to such studies are discussed.