Treatment options for younger AML patients

This article reviewed the options for induction therapy (therapy to induce remission) in younger patients (less than age 60) with acute myeloid leukemia (AML).

AML occurs due to genetic changes (mutations) to stem cells (immature blood cells). These genetic changes can cause AML cells to become resistant to treatment over time. The goal of early (induction) treatment is complete remission (CR, no sign of disease).

This article reviewed the options for induction therapy in younger AML patients.

Younger patients are more able to tolerate intensive chemotherapy than older patients. Intensive induction regimens are used more often in young, fit patients. Therapies to help patients recover from the toxic effects of chemotherapy have also helped with treatment intensification. Patients are generally treated with a combination of chemotherapies (cytarabine and an anthracycline such as daunorubicin). Targeted therapies (treatment that targets proteins involved in cancer growth) may also be used. The general induction treatment regimen includes 3 days of an anthracycline and 7 days of cytarabine (the 7+3 regimen).

Increased anthracycline doses, in combination with cytarabine, have been shown to be more effective at inducing CR. One study including 657 patients showed that 3 days of 90 mg/m² daunorubicin was more effective than 45 mg/m². A second study included patients treated with two inductions of daunorubicin. The first dose was 60 or 90 mg/m². The second dose was 150 mg/m². This study noted increased mortality and no improvement in relapse rates. The optimal dose and length of treatment is still unclear.

Idarubicin is another possible anthracycline. It has been shown to lead to increased side effects but similar survival.

Targeted therapies, such as gemtuzumab–ozogamicin (Mylotarg), can improve survival in patients with certain genetic abnormalities. Some patients have a genetic mutation that activates the FLT3 protein. This protein leads to increased cancer cell growth. The targeted therapy midostaurin has been shown to improve survival rates, but not CR rates.

This study outlined the options for induction therapy in younger, fit patients.