Improving the Remission Quality in Acute Myelogenous Leukemia (AML) by Increasing Cytoreduction During Induction Therapy

Abstract

Induction of remission in AML has, for many years, been achieved by the administration of daunorubicin with cytarabine [1]. With traditional doses of these drugs, approximately two-thirds of the patients treated have gone into remission. Roughly two-thirds of these have achieved their remission after the first cycle of therapy and one-third required additional treatment. Although physicians have consistently tried to increase the cure rate of patients with AML achieving CR by the administration of subsequent therapy, the “quality” of CR has never been thought to be vital, since post-induction chemotherapy was considered the most important aspect of treatment. Because of this, consolidation therapy has gone from gentle to very intense and has been given for as little as 1–2 months to as long as 1 year or more. Death, associated with delivery of this therapy, has varied between 0% and 40% [2, 3]. The therapy reported here is based on the presumption that, at the time of diagnosis or at relapse, with fully evident disease, the normal stem cells are asleep and somewhat protected from the chemotherapy that is administered. Therefore, induction treatment with high-dose cytarabine, mitoxantrone, and etoposide can be administered with less risk than previously expected. Indeed, it may be that, in most protocols, what is accomplished during “induction” therapy may be the most important element of treatment.