Improving long-term outcomes with intensive induction chemotherapy for patients with AML

Intensive chemotherapy in combination with allogeneic hematopoietic cell transplantation and supportive care can induce long - term remis sions in around 50 % of acute mye loid leu ke mia patients eli gi ble for inten sive treat ment. Several treatment optimization trials helped to refine schedule and dosing of the historic "7+3" combination. Together with the addi tion of novel agents, increased effi cacy and tol er a bil ity led to improved long - term out comes. Unsatisfactory out comes in fit elderly patients and unfa vor able genetic sub groups have raised the ques tion of whether less - inten sive venetoclax - based approaches may be ben e fi cial as an alter na tive. Although tempt ing and worth explor ing, this issue will remain controversial until the results of ran dom ized com par i sons appear. To date, inten sive che mo ther apy remains the only evi dent cura tive treat ment option for long - term dis ease erad i ca tion in a fixed treat ment time. With the advent of more novel agents and advances in min i mal resid ual dis ease (MRD) detec tion and main te nance approaches, the face of inten sive treat ment could change in many ways. Several are being explored in clin i cal tri als, such as (1) combi na tions of more than 1 novel agent with the inten sive back bone, (2) head - to - head com par i sons of novel agents, (3) replace ment or dose reduc tion of cyto toxic com po nents such as anthracyclines, and (4) MRD - guided esca la tion and de-escalation strategies. The combination of intensive treatment with individualized tailored innovative strategies will most cer tainly reduce treat ment - related toxicities and increase the chances for long - term remis sion in the future.