Dnešní možnosti léčby mladších nemocných s akutnímyeloidní leukémií

Current treatment options of acute myelogenous leukemia inyounger patients

The primary objective in treating patients with acute myelogenous leukemia (AML) is to induceremission and thereafter prevent relapse. Despite the fact that 60–80% of patients with AML achievecomplete remission after induction therapy most of them relapse and die of the disease.Once remissionhas been achieved, further intensive therapy is needed to prevent relapse. Younger patients have threemain options after going into remission: intensive postremission chemotherapy (chemotherapeuticcourses of various intensity have been evaluated without clear conclusion), autologous stem celltransplantation, or allogeneic stem cell transplantation. Allogeneic stem cell transplantation can curethe most of patients. Patients with standard-risk disease have traditionally been referred for matchedsibling allograft if donor is available. Patients with high-risk disease have been referred for matchedsibling or matched unrelated donor allograft. Transplantation is possibly unnecessary in low-riskpatients in first remission. Unfortunately, even today the high mortality of allograft is a problem. Therole of nonmyeloablative transplantations and peripheral blood stem cells (PBSC) transplantationremains unclear.The main reason for the increasing use of PBSC relies on rapid hematopoietic recoveryobserved with PBSC compared with bone marrow. However, PBSC transplantation might be associatedwith increased incidence and severity of acute graft-versus-host disease. There is a lot of obscurities intreatment of AML. While, during the last decades, the evolution of AML therapy was characterized byattempts to intensify all phases of treatment, increasing insights into the biology of this disease(cytogenetic features, molecular genetic features) now promise to lead to risk-adapted and moreeffective therapeutic approaches.

Key words:
acute myelogenous leukemia, prognostic factors, treatment