Current strategies for the treatment of acute myeloid leukemia

Abstract

Introduction. Acute myeloid leukemia is a rare malignancy with an average age of 70 years at diagnosis. Until recently, five-year survival of younger patients with this disease, despite being treated with allogenic hematopoietic stem cell transplantation, was < 30%, while in patients older than 60 years it was < 10%. Treatment overview. Due to the heterogeneity of acute myeloid leukemia no new drugs for treating this disease have been introduced for decades. The introduction of new drugs began from 2017: midostaurin, gilteritinib, CPX351, enasidenib, ivosidenib, venetoclax, glasdegib, while gemtuzumab ozogamicin has been reintroduced. Modern treatment strategies require an individual approach, based on prognostic parameters such as cytogenetical and molecular profile of acute myeloid leukemia at diagnosis and the assessment of minimal residual disease evaluated after two cycles of chemotherapy. Moreover, determining the eligibility of patients for ??intensive?? treatment, based on functional status, comorbidities and geriatric assessment of older patients, is necessary. Regarding the treatment of acute promyelocytic leukemia, the combination of arsenic trioxide and all-trans retinoic acid is universally accepted as the standard of care for non-high risk patients (WBC < 10x109/L), while standard chemotherapy combined with all-trans retinoic acid is still used for high-risk patients (WBC >10x109/L). Conclusion. Novel therapeutic modalities, along with allo-HSCT have changed the outcome of AML patients. However, treating patients unfit for intensive chemotherapy, as well as patients with relapse/refractory disease, is still challenging.