Frontline treatment of acute myeloid leukemia in adults

Gevorg Tamamyan, Tapan Kadia, Farhad Ravandi, Gautam Borthakur, Jorge Cortes, Elias Jabbour, Naval Daver, Maro Ohanian, Hagop Kantarjian, Marina Konopleva

Research output: Contribution to journalReview article

Abstract

Recent years have highlighted significant progress in understanding the underlying genetic and epigenetic signatures of acute myeloid leukemia(AML). Most importantly, novel chemotherapy and targeted strategies have led to improved outcomes in selected genetic subsets. AML is a remarkably heterogeneous disease, and individualized therapies for disease-specific characteristics (considering patients’ age, cytogenetics, and mutations) could yield better outcomes. Compared with the historical 5-to 10-year survival rate of 10%, the survival of patients who undergo modern treatment approaches reaches up to 40–50%, and for specific subsets, the improvements are even more dramatic; for example, in acute promyelocytic leukemia, the use of all-trans retinoic acid and arsenic trioxide improved survival from 30 to 40% up to 80 to 90%. Similar progress has been documented in core-binding-factor-AML, with an increase in survival from 30% to 80% upon the use of high-dose cytarabine/fludarabine/granulocyte colony-stimulating factor combination regimens. AML treatment was also recently influenced by the discovery of the superiority of regimens with higher dose Ara-C and nucleoside analogues compared with the “7 + 3”regimen, with about a 20% improvement in overall survival. Despite these significant differences, most centers continue to use the “7 + 3” regimen, and greater awareness will improve the outcome. The discovery of targetable molecular abnormalities and recent studies of targeted therapies (gemtuzumab ozagomycin, FLT3 inhibitors, isocitrate dehydrogenase inhibitors, and epigenetic therapies), future use of checkpoint inhibitors and other immune therapies such as chimeric antigen receptor T-cells, and maintenance strategies based on the minimal residual disease evaluation represent novel, exciting clinical leads aimed to improve AML outcomes in the near future.

Original languageEnglish (US)
Pages (from-to)20-34
Number of pages15
JournalCritical Reviews in Oncology/Hematology
Volume110
DOIs
StatePublished - Feb 1 2017
Externally publishedYes

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Acute Myeloid Leukemia
Survival
Cytarabine
Epigenomics
Therapeutics
Core Binding Factors
Isocitrate Dehydrogenase
Acute Promyelocytic Leukemia
Residual Neoplasm
Granulocyte Colony-Stimulating Factor
T-Cell Antigen Receptor
Tretinoin
Nucleosides
Cytogenetics
Survival Rate
Maintenance
Drug Therapy
Mutation

Keywords

  • Acute myeloid leukemia
  • Frontline treatment
  • High dose Ara-C
  • Nucleoside analogues

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

Tamamyan, G., Kadia, T., Ravandi, F., Borthakur, G., Cortes, J., Jabbour, E., ... Konopleva, M. (2017). Frontline treatment of acute myeloid leukemia in adults. Critical Reviews in Oncology/Hematology, 110, 20-34. https://doi.org/10.1016/j.critrevonc.2016.12.004

Frontline treatment of acute myeloid leukemia in adults. / Tamamyan, Gevorg; Kadia, Tapan; Ravandi, Farhad; Borthakur, Gautam; Cortes, Jorge; Jabbour, Elias; Daver, Naval; Ohanian, Maro; Kantarjian, Hagop; Konopleva, Marina.

In: Critical Reviews in Oncology/Hematology, Vol. 110, 01.02.2017, p. 20-34.

Research output: Contribution to journalReview article

Tamamyan, G, Kadia, T, Ravandi, F, Borthakur, G, Cortes, J, Jabbour, E, Daver, N, Ohanian, M, Kantarjian, H & Konopleva, M 2017, 'Frontline treatment of acute myeloid leukemia in adults', Critical Reviews in Oncology/Hematology, vol. 110, pp. 20-34. https://doi.org/10.1016/j.critrevonc.2016.12.004
Tamamyan, Gevorg ; Kadia, Tapan ; Ravandi, Farhad ; Borthakur, Gautam ; Cortes, Jorge ; Jabbour, Elias ; Daver, Naval ; Ohanian, Maro ; Kantarjian, Hagop ; Konopleva, Marina. / Frontline treatment of acute myeloid leukemia in adults. In: Critical Reviews in Oncology/Hematology. 2017 ; Vol. 110. pp. 20-34.
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