For younger patients with acute myeloid leukemia (AML), the current priority is to prevent disease relapse. Intensification of induction has been shown to achieve this. Several randomized trials have been conducted to evaluate the role of autografting in AML. All trials reduce the risk of relapse but do not necessarily improve the survival, either because the competing effects of procedural mortality or salvage after relapse balance the benefits. Patients with different risk profiles may have different treatment plans. In older patients, progress is difficult to detect. Overcoming inherent drug resistance is of current interest, while improving supportive care by the routine use of growth factors has been disappointing.
Department of Haematology, University of Wales College of Medicine, Heath Park, Cardiff CF4 4XN, UK.