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. Author manuscript; available in PMC: 2013 Mar 1.
Published in final edited form as: Pediatr Blood Cancer. 2011 Oct 28;58(3):334–343. doi: 10.1002/pbc.23385

Table II.

Evolution of Therapy for Acute Myeloid Leukemia

Treatment
Modality		 Decade Historic Treatment Modalities
Used in Contemporary Therapy
1960 1970 1980 1990 Post-2000
Chemotherapy Agents

  • Vincristine

  • 6 Mercaptopurine

  • Corticosteroids

  • Cyclophosphamide

  • Ara-C

  • Ara-C

  • Anthracyclines

  • 6 Thioguanine

  • Other anti-metabolites

  • High dose Ara-C

  • Etoposide

  • ATRA for APL

  • Increasing stratification of therapy based on traditional risk factors or molecular markers

  • High dose Ara-C

  • Daunomycin

  • Etoposide
Dose-Intensity/Duration

  • Low doses over 3–5 years

  • Low doses over 1.5 – 4 years

  • 6–8 months with aggressive post-remission therapy

  • Randomized trials show maintenance chemo reduces overall survival.

  • 3–4 aggressive courses total over 4–6 months

  • 3–4 aggressive courses total over 4–6 months
CNS Prophylaxis/Treatment

  • None/IT Ara-C

  • Lumbar punctures for symptomatic patients only

  • Prophylactic cranial irradiation

  • IT Ara-C/IT Ara-C-Methotrexate-Hydrocortisone (“Triples”)

  • Considering ↑ IT chemotherapy for patients at high risk

  • Intrathecal Ara-C
Bone Marrow Transplantation Not available

  • Experimental, with matched family donors only

  • Several “biologic randomized” trials showing superiority of allogeneic HCT over chemotherapy

  • Busulfan/cyclophosphamide for HCT conditioning

  • Use of alternative transplants for high risk patients in first CR

  • HCT reserved for high risk (unfavorable cytogenetics or residual/refractory disease after induction)
Radiation Therapy

  • Treatment of granulocytic sarcoma (chloroma) only

  • Prophylactic cranial irradiation

  • Radiation therapy used only for CNS relapse and granulocytic sarcoma

  • No CNS irradiation, even at initial relapse

  • Radiation therapy only for granulocytic sarcoma compromising organ function

  • Irradiation limited to CNS disease refractory to systemic chemotherapy or granulocytic sarcoma compromising organ function.

APL - acute promyelocytic leukemia; Ara C – cytosine arabinoside; ATRA - all trans-retinoic acid; CNS – central nervous system; CR – complete remission; HCT – hematopoietic cell transplantation; IT – intrathecal