Current options in the management of acute myeloid leukaemia

摘要

Acute myeloid leukaemia (AML) accounts for less than 1% of human malignancies, although the importance of this disease far outweighs its low incidence. The accessibility of leukaemic tissue has enabled extensive study of the cellular and molecular basis of haematological malignancies and other cancers. So far, however, it has been difficult to transfer this increased understanding into therapeutic benefit. Some advance has been made in determining which subgroups of patients with AML will do well with conventional therapy, and which will do badly and therefore benefit from alternative, usually experimental, approaches. The morphological classification of AML by the French-American-British (FAB) group has been shown to provide limited prognostic information, with only the M3 variant (acute promye-locytic leukaemia) behaving substantially differently from the other seven subgroups. It has been known for some time that AML evolving from a pre-existing chronic disorder such as myelodysplasia (MDS) or chronic leukaemia has a poorer outcome. It is now clear that cytogenetic abnormalities of the leukaemic clone, such as translocations of chromosomes 15 and 17 (t15:17), associated exclusively with AML M3, inversions of 16 or t(8:21), confer a good prognosis, although the precise reasons are multi-factorial.