Consolidation Therapy in Acute Myeloid Leukemia

In this chapter, case studies illustrate the importance of consolidation therapy for acute myeloid leukemia (AML) patients. Although up to 80% of patients younger than 60 years will enter complete remission (CR) following a standard induction regimen, in one study 100% of patients in CR randomized to receive no further therapy relapsed at a median time of 4.1 months, with all patients relapsing by 17 months. Current evidence supports the use of a risk-adapted strategy emphasizing consolidation chemotherapy for patients with good-risk disease and allogeneic hematopoietic stem cell transplantation (allo-HSCT) for patients with adverse-risk disease. For favorable-risk patients with core binding factor (CBF) AML, postremission therapy with multiple cycles of high-dose cytarabine (HDAC) has been shown to significantly improve survival compared to either standard doses of cytarabine or multi-agent chemotherapy. Auto-HSCT has been considered an alternate postremission strategy for many years. It provides significantly lower relapse rates, but at the expense of slightly greater toxicity and reduced success of salvage therapies. No significant differences in OS between postremission chemotherapy and auto-HSCT have been reported. At this time, there is no role for maintenance cytotoxic chemotherapy in younger patients with AML who are able to tolerate standard treatments, and there is currently no standard postremission therapy for patients over the age of 60 who achieve CR. Generally, a clinical trial should be the first choice for treatment of elderly patients with AML.