Upfront Therapy of Acute Myeloid Leukemia

Acute myeloid leukemia is a clinically and biologically heterogeneous disease. Standard induction chemotherapy, consisting of cytarabine and an anthracycline, has not changed substantially over several decades, and outcomes remain suboptimal, particularly in older patients. Many genetic and molecular changes have been identified that guide selection of post-remission therapy and for which targeted therapies are beginning to be developed and tested. These research efforts are resulting in gradual improvement in outcomes. We will review here recent advances in induction chemotherapy, including anthracycline dose intensification in younger patients, treatment selection and use of novel agents in upfront therapy for older patients, and risk-adapted post-remission therapy.