Increasingly intensive chemotherapy over the last 30 years has improved the prospects of longterm cure for some people with AML. A review of data for 1414 adult patients treated on six Eastern Cooperative Group (ECOG) protocols from 1976-94 reported a 15% overall survival (OS) at 5 years. 1 On successive protocols with increasingly intensive post-remission therapy, OS increased from 9 to 33% for patients aged <55 years. More recently the MRC AML10 trial reported a 7-year OS of 40% for 1966 patients aged <56 years. 2 There was a highly significant reduction in the relapse rate compared to the earlier AML9 trial in which less intensive treatments were used. 3 Unfortunately over 50% of patients with AML are >60 years old and for these patients the chance of cure has probably not improved. The ECOG review found the 5-year OS in this group had increased from 6 to 13% while a similar review of Southwest Oncology Group (SWOG) trials from 1978-90 found that 8-year OS had not improved. 4 In the last 25 years a wide spectrum of cytogenetic and molecular lesions has been described in AML. Further study may eventually reveal common cellular mechanisms of leukemic transformation and suggest targets for novel therapies. Meanwhile it is increasingly appreciated that these lesions have prognostic and therapeutic implications. For example, in the MRC AML10 trial AML associated with t(15;17), t(8;21) or inv16 had a relatively favourable outcome, whereas AML associated with -5, 5q-, -7, abnormalities of chromosome 3 or complex karyotypes had a relatively unfavourable prognosis. The 5-year OS for favourable, intermediate and unfavourable karyotypes was 65, 41 and 14% respectively. 5 This review discusses progress in the use of chemotherapy and transplantation, advances in the application of cytogenetic and molecular data in the management of AML, and more recent novel approaches to the management of AML in adults.
REMISSION INDUCTION THERAPY
A series of trials undertaken by SWOG in the 1980s established the combination of daunorubicin 45 mg/m 2 for 3 days and cytarabine 100 mg/m 2 for 7 days by continuous infusion as the standard against which new induction regimens should probably be compared. 6 With this DA 3+7 regimen, CR rates of 50-75% were achieved. The use of alternative anthracyclines,