Current approaches in the treatment of relapsed and refractory acute myeloid leukemia

The limited sensitivity of the historical treatment response criteria for acute myeloid leukemia (AML) has resulted in a different paradigm for treatment compared with most other cancers presenting with widely disseminated disease Initial cytotoxic induction chemotherapy is often able to reduce tumor burden to a level sufficient to meet the current criteria for “complete” remission Nevertheless most AML patients ultimately die from their disease most commonly as clinically evident relapsed AML Despite a variety of available salvage therapy options prognosis in patients with relapsed or refractory AML is generally poor In this review we outline the commonly utilized salvage cytotoxic therapy interventions and then highlight novel investigational efforts currently in clinical trials using both pathway-targeted agents and immunotherapy based approaches We conclude that there is no current standard of care for adult relapsed or refractory AML other than offering referral to an appropriate clinical trial