The Cancer and Leukaemia Group B (CALGB) have determined that for patients aged below 60, high dose cytarabine given after induction can double the likelihood of disease-free survival compared to standard intensification. Immunotherapy has no established role in AML, nor dose maintenance therapy.
Certain karyotypes have more favourable prognoses, with improved long-term disease-free survival. These include genetic alterations such as translocations t(8;21) and t(15;17) and an abnormal 16q22. In contrast, all other karyotype abnormalities confer an adverse prognosis. For those patients with AML who appear to have a normal diploid karyotype, the prognosis is somewhere in between. Although, there is some correlation of karyotype with morphology, the association is weak. Karyotype outweighs age in defining prognosis. Bone marrow transplantation is not significantly superior in first remission and the results are significantly influenced by karyotype.
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