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Modern therapy of acute myeloid leukaemia


Authors: M. Čerňan;  T. Szotkowski
Authors‘ workplace: Hemato-onkologická klinika LF UP a FN Olomouc
Published in: Transfuze Hematol. dnes,23, 2017, No. 1, p. 16-28.
Category: Comprehensive Reports, Original Papers, Case Reports

Overview

Acute myeloid leukaemia is a clonal malignant disease affecting mainly elderly patients. This previously nearly always fatal disease is now curable in 35–40 % of younger patients. The basis of curative therapy has for several decades been induction chemotherapy using the protocol “7 + 3”, followed by consolidation therapy. A large proportion of patients treated with chemotherapy alone undergo relapse soon after treatment and die from disease progression. Allogeneic stem cell transplantation remains the most effective consolidation strategy for patients with intermediate and unfavourable prognosis based on cytogenetics. Cytogenetic and molecular-biology analyses show high heterogeneity of the disease. Acute myeloid leukaemia often arises from recurrent genetic changes that represent potential therapeutic targets for new drugs. Modern treatment modalities should involve molecularly targeted therapy, capable of stopping proliferation, in combination with chemotherapy and eradication of malignantly modified hematopoietic cells in the bone marrow without the need for allogeneic stem cell transplantation, analogously to the treatment of acute promyelocytic leukaemia. As the population ages, the number of patients with acute myeloid leukaemia is constantly growing and the need for new drugs is becoming urgent. A better understanding of disease biology and the development of new classes of drugs are essential prerequisites for improving patient prognosis. The article presents a review of current therapeutic strategies and new treatment modalities in the field of acute myeloid leukaemia therapy.

KEY WORDS:
acute myeloid leukaemia – induction chemotherapy – consolidation – transplantation – hypomethylating agents – FLT3 inhibitors


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