What is the best induction regimen for acute myelogenous leukemia?

The pursuit of the best induction regimen for acute myelogenous leukemia (AML) continues in an attempt to improve complete response rates and long-term disease free and overall survival. At this time, standard induction therapy generally consists of an anthracycline, most commonly daunorubicin given at a dose of 45-60 mg/m2 intravenously for 3 days and cytarabine arabinoside (ara-C) given at a dose of 100-200 mg/m2 intravenously by continuous infusion for 7 days. This regimen is based on findings from classic studies conducted from the late 1960s through the 1980s. Research on intensifying induction therapy has continued over the past decade. Potential strategies for intensifying induction therapy include (1) modulation of the anthracycline dose or agent; (2) modulation of ara-C; (3) the addition of other agents to standard induction therapy; (4) timed-sequential therapy; and (5) very early intensification therapy. Accurate interpretation of results from studies of intensifying induction therapy requires consideration of variables such as patient age, study inclusion criteria (eg, antecedent myelodysplasia), supportive care and, most importantly, patient selection. Furthermore, any benefit in long-term outcome during induction cannot be determined without regard to the choice of postremission therapy.