Management of primary and treatment-related acute myelogenous leukemia.

Modern treatment regimens achieve a full recovery in 40 to 50% of children with acute myelogenous leukemia (AML), Age younger than adverse prognostic significance. Remission rates range from 75 to 90% after induction therapy with one or two courses of cytarabine (7 days) and anthracycline (3 days). More aggressive induction regimens are probably more effective but carry a higher risk of fatal infection and can only be used in specialized units. Consolidation/intensification therapy has a major influence on disease-free survival. Allogenic bone marrow transplantation is the treatment of choice in patients with an HLA-compatible sibling. Conditioning regimens that do not involve total body irradiation are associated with milder posttransplantation sequelae. In nontransplanted patients, high-dose cytarabine therapy during the intensification phase is associated with better outcomes. Autologous bone marrow transplantation yields results similar to those of aggressive intensification chemotherapy. Maintenance treatment after the intensification phase has not been found to increase survival, and may even have the opposite effect. Prophylactic treatment to the CNS relies mainly on intrathecal chemotherapy, and brain radiation is necessary only in patients with meningeal involvement at diagnosis. Retinoic acid and chemotherapy is the best treatment in promyelocytic leukemia. Interleukin-2 therapy, drug resistance reversion, and use of molecular methods to monitor minimal residual disease are approaches that carry hope for future improvements in the treatment of AML.