Adult acute myeloid leukaemia: update on treatment

Adult acute myeloid leukaemia (AML) is uncommon, with an age-standardised incidence of approximately 3 per 100,000. Patients present (median age, > 60 years) with evidence of bone marrow failure, anaemia, leukopenia or thrombocytopenia and their sequelae, or AML is detected incidentally by a full blood count. Treatment for AML aims to eliminate leukaemia from bone marrow with intensive chemotherapy: age (over or under 60 years) and performance status determines whether standard or high-dose chemotherapy can be used, but fewer than half the patients with AML are under 60 years. Supportive therapy during initial induction chemotherapy is needed to control neutropenic sepsis and thrombocytopenic bleeding, and to ameliorate the side effects of chemotherapy. Standard induction chemotherapy produces complete remission in 56%-74% of patients; 20% are long term survivors; 10%-15% of patients die in the induction period. Allogeneic haemopoietic stem cell transplantation is recommended in patients under 50 years with an HLA-compatible sibling, with the best outcomes achieved in patients transplanted in first complete remission. It can also provide long term survival in patients who fail to achieve remission after induction therapy. The outcome of AML has improved, particularly for younger patients, but treatment outcomes for older patients and those with secondary leukaemia are still unsatisfactory. The mean overall survival of patients in randomised studies treated with standard therapy is still only 9-15 months.