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Arch Hellen Med, 22(3), May-June 2005, 221-238


Curative strategies in acute myeloid leukemia in younger adults

Department of Clinical Hematology, "G. Gennimatas" Athens General Hospital, Athens, Greece

The treatment of acute myeloid leukemia (ΑML) generally involves the administration of cytotoxic chemotherapy to eradicate the malignant cells, which permits restoration of normal hematopoiesis by normal residual stem cells. The outcome for adults with AML depends not only on the age of the patient but also on the intensity of post-remission therapy and on the biologic characteristics of the disease, including the karyotype and the expression of the multidrug resistant (mdr) phenotype. The French-American-British (FAB) classification allows the uniformity of diagnosis at morphologic subtypes of AML. The new WHO classification correlates morphology, cytochemistry, immunophenotype, karyotype, and molecular genetics with clinical features. Improvements in outcome have been achieved primarily because of better supportive care, post-remission intensive chemotherapy (IC), autologous stem cell transplantation (auto-SCT) or allogeneic stem cell transplantation (allo-SCT). Patients with standard-risk disease have traditionally been referred for a matched sibling allograft if a donor is available and the patient's performance status is adequate. In recent years, chemotherapy postremission has improved outcome, with 50% 5-year overall survival (OS) and 40% disease-free survival (DFS) similar to that achieved with allo-SCT, narrowing the differences between chemotherapy and such transplants.

Key words: Acute myeloid leukemia, Allo-SCT, Auto-SCT, Complete remission, Post-remission therapy, Remission induction.

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