Anthracycline dose intensification in young adults with acute myeloid leukemia.

The initial treatment for acute myeloid leukemia (AML) has remained largely unchanged for nearly 40 years. Our growing understanding of the molecular pathology of AML has resulted in improved measures to risk stratify patients by recurrent cytogenetic and molecular abnormalities without marked advancement in its initial treatment. The most common regimen consists of a 3-day course of an anthracycline and a 7-day infusion of cytarabine. This regimen has been employed across the globe in various iterations for many years with modest improvements in results yet this remains the first choice for the treatment of younger adults with AML. Despite this, the chemotherapeutic agents in this regimen are only now being fully understood. Recent evidence has suggested that dose intensification of anthracycline in young adults has a significant survival benefit. In this paper we review the evidence behind the use of anthracyclines in the initial induction of AML in younger adults focusing on the choice and dose of this long used drug combination.