Approaches to induction therapy with adult acute myeloid leukaemia.

Induction therapy of acute myeloid leukaemia (AML) with standard-dose chemotherapy will result in approximately 64% of patients achieving a complete remission (CR). New drugs which are active in induction therapy in randomised clinical trials are etoposide, idarubicin and high dose cytarabine. Intensification of induction treatment with etoposide or high-dose cytarabine does not appear to alter the CR rate but prolongs remission and has some impact on survival. High-dose cytarabine in induction combinations increase relapse-free survival compared to standard approaches. These induction results appear to parallel results obtained with post-remission therapies intensified with high-dose cytarabine. These studies provide clinical evidence that intensified induction with cytarabine in AML influences subsequent outcome but is more toxic, gives more profound myelosuppression post-remission and has benefit confined to younger patients.