Acute Myeloid Leukemia: Treatment Treatment of the newly diagnosed patient with AML is usually divided into two phases, induction and postremission management (Fig. 104-2). The initial goal is to quickly induce CR. Once CR is obtained, further therapy must be used to prolong survival and achieve cure. The initial induction treatment and subsequent postremission therapy are often chosen based on the patient's age. | Chapter 104. Acute and Chronic Myeloid Leukemia Part 7 Acute Myeloid Leukemia Treatment Treatment of the newly diagnosed patient with AML is usually divided into two phases induction and postremission management Fig. 104-2 . The initial goal is to quickly induce CR. Once CR is obtained further therapy must be used to prolong survival and achieve cure. The initial induction treatment and subsequent postremission therapy are often chosen based on the patient s age. The influence of intensifying therapy with traditional chemotherapy agents such as cytarabine and anthracyclines in younger patients 60 years appears to increase the cure rate of AML. In older patients the benefit of intensive therapy is controversial novel therapies are being pursued. Figure 104-2 Flow chart for the therapy of newly diagnosed acute myeloid leukemia. For all forms of AML except acute promyelocytic leukemia APL standard therapy includes a 7-day continuous infusion of cytarabine 100-200 mg m2 per day and a 3-day course of daunorubicin 45-60 mg m2 per day or idarubicin 12-13 mg m2 per day with or without 3 days of etoposide. Patients who achieve complete remission undergo postremission consolidation therapy including sequential courses of high-dose cytarabine autologous stem cell transplant SCT high-dose combination chemotherapy with allogeneic SCT or novel therapies based on their predicted risk of relapse . risk-stratified therapy . Patients with APL usually receive tretinoin together with anthracycline chemotherapy for remission induction and then consolidation chemotherapy daunorubicin followed by maintenance tretinoin with or without chemotherapy. The role of cytarabine in APL induction and consolidation is controversial. Induction Chemotherapy The most commonly used CR induction regimens for patients other than those with APL consist of combination chemotherapy with cytarabine and an anthracycline. Cytarabine is a cell cycle S-phase-specific antimetabolite that becomes phosphorylated
