Haema 2017; 8(2): 168-178
by Anastasia Skandali1, Panagiotis Tsirigotis2
1Hematologist, Head, Department of Haematology, “Hygeia” Hospital, Athens, Greece,
2Assistant Professor of Hematology, National and Kapodistrian University of Athens, 2nd Department of Propedeutic Internal Medicine, “Attikon” University General Hospital, Athens, Greece
Abstract
Despite considerable progress in our understanding of the genetic heterogeneity and the molecular pathogenesis of acute myeloid leukemia (AML), the identification of prognostic factors, and the rapidly increased treatment options, the overall outcome of AML patients remains unsatisfactory, particularly for the patients older than 60-65 years. Although some improvement during the last 4 decades is apparent among younger patients, still only ~35% of such patients entered on clinical trials are cured of their disease. The majority of AML patients succumb to their disease primarily due to resistance to treatment or to relapse of the disease. Over several decades our approach to the first step of treatment (induction therapy) has largely remained the same, but our approach to the second step (postremission therapy) has evolved significantly. The prospect for durable disease control with the offer of intensified chemotherapy or with hematopoietic stem cell transplantation is based on the identification of biologic markers present at diagnosis before treatment and the characterization of minimal residual treatment after induction therapy. Insights gathered incrementally from research have allowed tailoring treatment and avoid the “one size fits all” approach. New treatment strategies generate genuine excitement about the future.