Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • How to Manage…
  • Published:

How to Manage…

How to manage high-risk acute myeloid leukemia

Leukemia volume 26, pages 861–869 (2012)Cite this article

Abstract

There are three general options for management of acute myeloid leukemia (AML): standard therapy, investigational therapy or no treatment other than supportive care. Given AML's natural history and the uncertain results inherent in investigational therapy, most patients intuitively prefer standard therapy, by which is usually meant 3+7 or low-dose cytarabine. However, this preference assumes results with standard therapy are ‘satisfactory’. Results with standard therapy of AML are, however, so variable that it is difficult to speak of a single result. Therefore, I review prognostic factors with standard therapy to permit physicians to better inform patients of the likely outcome with such therapy, realizing that the same data might prompt one patient/physician to prefer standard therapy and another investigational therapy under the assumption that although plausibly worse than standard the latter cannot be that much worse. Because even in patients aged >75 years, the principal cause of therapeutic failure is resistance to therapy not treatment-related mortality, I emphasize factors associated with resistance, principally a ‘monosomal karyotype’ and various molecular markers and extend the European Leukemia Net prognostic system. I also stress the value of waiting for cytogenetic and molecular results before beginning induction therapy and review various investigational options.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. Freireich EJ, Gehan EA, Sulman D, Boggs DR, Frei 3rd E . The effect of chemotherapy on acute leukemia in the human. J Chronic Dis 1961; 14: 593–608.

    Article  CAS  PubMed  Google Scholar 

  2. Walter RB, Appelbaum FR, Tallman MS, Weiss NS, Larson RA, Estey EH . Shortcomings in the clinical evaluation of new drugs: acute myeloid leukemia as paradigm. Blood 2010; 116: 2420–2428.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Estey E, Smith TL, Keating MJ, McCredie KB, Gehan EA, Freireich EJ . Prediction of survival during induction therapy in patients with newly diagnosed acute myeloblastic leukemia. Leukemia 1989; 3: 257–263.

    CAS  PubMed  Google Scholar 

  4. Walter R, Othus M, Borthakur G, Ravandi F, Cortes JE, Pierce SA et al. Quantitative effect of age in predicting empirically-defined treatment-related mortality and resistance in newly diagnosed AML: case against age alone as primary determinant of treatment assignment. Blood 2010; 116; 904.

    Article  Google Scholar 

  5. Krug U, Rollig C, Koschmieder A, Heinecke A, Sauerland MC, Schaich M et al. Complete remission and early death after intensive chemotherapy in patients aged 60 years or older with acute myeloid leukaemia: a web-based application for prediction of outcomes. Lancet 2010; 376: 2000–2008.

    Article  CAS  PubMed  Google Scholar 

  6. Sorror M . Impacts of pretransplant comorbidities on allogeneic hematopoietic cell transplantation (HCT) outcomes. Biol Blood Marrow Transplant 2009; 15: 149–153.

    Article  PubMed  Google Scholar 

  7. Sorror ML . Comorbidities and hematopoietic cell transplantation outcomes. Hematol Am Soc Hematol Educ Program 2010; 2010: 237–247.

    Article  Google Scholar 

  8. Appelbaum FR, Gundacker H, Head DR, Slovak ML, Willman CL, Godwin JE et al. Age and acute myeloid leukemia. Blood 2006; 107: 3481–3485.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Yanada M, Garcia-Manero G, Borthakur G, Ravandi F, Kantarjian H, Estey E . Relapse and death during first remission in acute myeloid leukemia. Haematologica 2008; 93: 633–634.

    Article  PubMed  Google Scholar 

  10. Tilly H, Castaigne S, Bordessoule D, Casassus P, Le Prise PY, Tertian G et al. Low-dose cytarabine versus intensive chemotherapy in the treatment of acute nonlymphocytic leukemia in the elderly. J Clin Oncol 1990; 8: 272–279.

    Article  CAS  PubMed  Google Scholar 

  11. Breems DA, Van Putten WL, De Greef GE, Van Zelderen-Bhola SL, Gerssen-Schoorl KB, Mellink CH et al. Monosomal karyotype in acute myeloid leukemia: a better indicator of poor prognosis than a complex karyotype. J Clin Oncol 2008; 26: 4791–4797.

    Article  PubMed  Google Scholar 

  12. Medeiros BC, Othus M, Fang M, Roulston D, Appelbaum FR . Prognostic impact of monosomal karyotype in young adult and elderly acute myeloid leukemia: the Southwest Oncology Group (SWOG) experience. Blood 2010; 116: 2224–2228.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Schlenk RF, Dohner K, Krauter J, Frohling S, Corbacioglu A, Bullinger L et al. Mutations and treatment outcome in cytogenetically normal acute myeloid leukemia. N Engl J Med 2008; 358: 1909–1918.

    Article  CAS  PubMed  Google Scholar 

  14. Whitman SP, Maharry K, Radmacher MD, Becker H, Mrozek K, Margeson D et al. FLT3 internal tandem duplication associates with adverse outcome and gene- and microRNA-expression signatures in patients 60 years of age or older with primary cytogenetically normal acute myeloid leukemia: a Cancer and Leukemia Group B study. Blood 2010; 116: 3622–3626.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Becker H, Marcucci G, Maharry K, Radmacher MD, Mrozek K, Margeson D et al. Favorable prognostic impact of NPM1 mutations in older patients with cytogenetically normal de novo acute myeloid leukemia and associated gene- and microRNA-expression signatures: a Cancer and Leukemia Group B study. J Clin Oncol 2010; 28: 596–604.

    Article  CAS  PubMed  Google Scholar 

  16. Dohner H, Estey EH, Amadori S, Appelbaum FR, Buchner T, Burnett AK et al. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood 2010; 115: 453–474.

    Article  PubMed  Google Scholar 

  17. Paschka P, Marcucci G, Ruppert AS, Mrozek K, Chen H, Kittles RA et al. Adverse prognostic significance of KIT mutations in adult acute myeloid leukemia with inv(16) and t(8;21): a Cancer and Leukemia Group B Study. J Clin Oncol 2006; 24: 3904–3911.

    Article  CAS  PubMed  Google Scholar 

  18. Schnittger S, Kohl TM, Haferlach T, Kern W, Hiddemann W, Spiekermann K et al. KIT-D816 mutations in AML1-ETO-positive AML are associated with impaired event-free and overall survival. Blood 2006; 107: 1791–1799.

    Article  CAS  PubMed  Google Scholar 

  19. Nguyen S, Leblanc T, Fenaux P, Witz F, Blaise D, Pigneux A et al. A white blood cell index as the main prognostic factor in t(8;21) acute myeloid leukemia (AML): a survey of 161 cases from the French AML Intergroup. Blood 2002; 99: 3517–3523.

    Article  CAS  PubMed  Google Scholar 

  20. Appelbaum FR, Kopecky KJ, Tallman MS, Slovak ML, Gundacker HM, Kim HT et al. The clinical spectrum of adult acute myeloid leukaemia associated with core binding factor translocations. Br J Haematol 2006; 135: 165–173.

    Article  PubMed  Google Scholar 

  21. Delaunay J, Vey N, Leblanc T, Fenaux P, Rigal-Huguet F, Witz F et al. Prognosis of inv(16)/t(16;16) acute myeloid leukemia (AML): a survey of 110 cases from the French AML Intergroup. Blood 2003; 102: 462–469.

    Article  CAS  PubMed  Google Scholar 

  22. Marcucci G, Haferlach T, Dohner H . Molecular genetics of adult acute myeloid leukemia: prognostic and therapeutic implications. J Clin Oncol 2011; 29: 475–486.

    Article  CAS  PubMed  Google Scholar 

  23. Estey E, Kornblau S, Pierce S, Kantarjian H, Beran M, Keating M . A stratification system for evaluating and selecting therapies in patients with relapsed or primary refractory acute myelogenous leukemia. Blood 1996; 88: 756.

    CAS  PubMed  Google Scholar 

  24. Breems DA, Van Putten WL, Huijgens PC, Ossenkoppele GJ, Verhoef GE, Verdonck LF et al. Prognostic index for adult patients with acute myeloid leukemia in first relapse. J Clin Oncol 2005; 23: 1969–1978.

    Article  PubMed  Google Scholar 

  25. Kern W, Haferlach C, Haferlach T, Schnittger S . Monitoring of minimal residual disease in acute myeloid leukemia. Cancer 2008; 112: 4–16.

    Article  CAS  PubMed  Google Scholar 

  26. Cilloni D, Renneville A, Hermitte F, Hills RK, Daly S, Jovanovic JV et al. Real-time quantitative polymerase chain reaction detection of minimal residual disease by standardized WT1 assay to enhance risk stratification in acute myeloid leukemia: a European LeukemiaNet study. J Clin Oncol 2009; 27: 5195–5201.

    Article  CAS  PubMed  Google Scholar 

  27. Kronke J, Schlenk RF, Jensen KO, Tschurtz F, Corbacioglu A, Gaidzik VI et al. Monitoring of minimal residual disease in NPM1-mutated acute myeloid leukemia: a study from the German-Austrian acute myeloid leukemia study group. J Clin Oncol 2011; 29: 2709–2716.

    Article  PubMed  Google Scholar 

  28. Buccisano F, Maurillo L, Spagnoli A, Del Principe MI, Fraboni D, Panetta P et al. Cytogenetic and molecular diagnostic characterization combined to postconsolidation minimal residual disease assessment by flow cytometry improves risk stratification in adult acute myeloid leukemia. Blood 2010; 116: 2295–2303.

    Article  CAS  PubMed  Google Scholar 

  29. Slovak ML, Kopecky KJ, Cassileth PA, Harrington DH, Theil KS, Mohamed A et al. Karyotypic analysis predicts outcome of preremission and postremission therapy in adult acute myeloid leukemia: a Southwest Oncology Group/Eastern Cooperative Oncology Group Study. Blood 2000; 96: 4075–4083.

    CAS  PubMed  Google Scholar 

  30. Fernandez HF, Sun Z, Yao X, Litzow MR, Luger SM, Paietta EM et al. Anthracycline dose intensification in acute myeloid leukemia. N Engl J Med 2009; 361: 1249–1259.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Lowenberg B, Ossenkoppele GJ, van Putten W, Schouten HC, Graux C, Ferrant A et al. High-dose daunorubicin in older patients with acute myeloid leukemia. N Engl J Med 2009; 361: 1235–1248.

    Article  PubMed  Google Scholar 

  32. Lowenberg B, Pabst T, Vellenga E, van Putten W, Schouten HC, Graux C et al. Cytarabine dose for acute myeloid leukemia. N Engl J Med 2011; 364: 1027–1036.

    Article  PubMed  Google Scholar 

  33. Bloomfield CD, Lawrence D, Byrd JC, Carroll A, Pettenati MJ, Tantravahi R et al. Frequency of prolonged remission duration after high-dose cytarabine intensification in acute myeloid leukemia varies by cytogenetic subtype. Cancer Res 1998; 58: 4173–4179.

    CAS  PubMed  Google Scholar 

  34. Woods WG, Kobrinsky N, Buckley JD, Lee JW, Sanders J, Neudorf S et al. Timed-sequential induction therapy improves postremission outcome in acute myeloid leukemia: a report from the Children's Cancer Group. Blood 1996; 87: 4979–4989.

    CAS  PubMed  Google Scholar 

  35. Walter RB, Gooley TA, Wood BL, Milano F, Fang M, Sorror ML et al. Impact of pretransplantation minimal residual disease, as detected by multiparametric flow cytometry, on outcome of myeloablative hematopoietic cell transplantation for acute myeloid leukemia. J Clin Oncol 2011; 29: 1190–1197.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Sekeres MA, Elson P, Kalaycio ME, Advani AS, Copelan EA, Faderl S et al. Time from diagnosis to treatment initiation predicts survival in younger, but not older, acute myeloid leukemia patients. Blood 2009; 113: 28–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Wheatley K, Brookes CL, Howman AJ, Goldstone AH, Milligan DW, Prentice AG et al. Prognostic factor analysis of the survival of elderly patients with AML in the MRC AML11 and LRF AML14 trials. Br J Haematol 2009; 145: 598–605.

    Article  PubMed  Google Scholar 

  38. Malfuson JV, Etienne A, Turlure P, de Revel T, Thomas X, Contentin N et al. Risk factors and decision criteria for intensive chemotherapy in older patients with acute myeloid leukemia. Haematologica 2008; 93: 1806–1813.

    Article  CAS  PubMed  Google Scholar 

  39. Juliusson G, Antunovic P, Derolf A, Lehmann S, Mollgard L, Stockelberg D et al. Age and acute myeloid leukemia: real world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry. Blood 2009; 113: 4179–4187.

    Article  CAS  PubMed  Google Scholar 

  40. Kantarjian H, Ravandi F, O’Brien S, Cortes J, Faderl S, Garcia-Manero G et al. Intensive chemotherapy does not benefit most older patients (age 70 years or older) with acute myeloid leukemia. Blood 2010; 116: 4422–4429.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Holowiecki J, Grosicki S, Robak T, Kyrcz-Krzemien S, Giebel S, Hellmann A et al. Addition of cladribine to daunorubicin and cytarabine increases complete remission rate after a single course of induction treatment in acute myeloid leukemia. Multicenter, phase III study. Leukemia 2004; 18: 989–997.

    Article  CAS  PubMed  Google Scholar 

  42. Burnett AK, Russell NH, Kell J, Dennis M, Milligan D, Paolini S et al. European development of clofarabine as treatment for older patients with acute myeloid leukemia considered unsuitable for intensive chemotherapy. J Clin Oncol 2010; 28: 2389–2395.

    Article  CAS  PubMed  Google Scholar 

  43. Faderl S, Ravandi F, Huang X, Garcia-Manero G, Ferrajoli A, Estrov Z et al. A randomized study of clofarabine versus clofarabine plus low-dose cytarabine as front-line therapy for patients aged 60 years and older with acute myeloid leukemia and high-risk myelodysplastic syndrome. Blood 2008; 112: 1638–1645.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Fenaux P, Mufti GJ, Hellstrom-Lindberg E, Santini V, Gattermann N, Germing U et al. Azacitidine prolongs overall survival compared with conventional care regimens in elderly patients with low bone marrow blast count acute myeloid leukemia. J Clin Oncol 2010; 28: 562–569.

    Article  CAS  PubMed  Google Scholar 

  45. Walter RB, Kantarjian HM, Huang X, Pierce SA, Sun Z, Gundacker HM et al. Effect of complete remission and responses less than complete remission on survival in acute myeloid leukemia: a combined Eastern Cooperative Oncology Group, Southwest Oncology Group, and M. D. Anderson Cancer Center Study. J Clin Oncol 2010; 28: 1766–1771.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Thomas XG . Results from a randomized phase III trial of decitabine versus supportive care or low-dose cytarabine for the treatment of older patients with newly diagnosed AML [ASCO abstract 6504]. J Clin Oncol 2011; 29 (Suppl 1): 6504.

    Article  Google Scholar 

  47. Scandura JM, Roboz GJ, Moh M, Morawa EW, Brenet F, Bose JR et al. Phase I study of epigenetic priming with decitabine prior to standard induction chemotherapy for patients with AML. Blood 2011; 118: 1472–1480.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Blum W, Garzon R, Klisovic RB, Schwind S, Walker A, Geyer S et al. Clinical response and miR-29b predictive significance in older AML patients treated with a 10-day schedule of decitabine. Proc Natl Acad Sci USA 2010; 107: 7473–7478.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Burnett AK, Goldstone AH, Stevens RM, Hann IM, Rees JK, Gray RG et al. Randomised comparison of addition of autologous bone-marrow transplantation to intensive chemotherapy for acute myeloid leukaemia in first remission: results of MRC AML 10 trial. UK Medical Research Council Adult and Children's Leukaemia Working Parties. Lancet 1998; 351: 700–708.

    Article  CAS  PubMed  Google Scholar 

  50. Wheatley K, Gray R . Commentary: Mendelian randomization--an update on its use to evaluate allogeneic stem cell transplantation in leukaemia. Int J Epidemiol 2004; 33: 15–17.

    Article  PubMed  Google Scholar 

  51. Mantel N, Byar DB . Evaluation of response time data involving transient states: an illustration using heart-transplantation data. J Am Stat Assoc 1974; 69: 81–86.

    Article  Google Scholar 

  52. Koreth J, Schlenk R, Kopecky KJ, Honda S, Sierra J, Djulbegovic BJ et al. Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials. JAMA 2009; 301: 2349–2361.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Appelbaum FR . Incorporating hematopoietic cell transplantation (HCT) into the management of adults aged under 60 years with acute myeloid leukemia (AML). Best Pract Res Clin Haematol 2008; 21: 85–92.

    Article  PubMed  Google Scholar 

  54. Martin PJ, Counts Jr GW, Appelbaum FR, Lee SJ, Sanders JE, Deeg HJ et al. Life expectancy in patients surviving more than 5 years after hematopoietic cell transplantation. J Clin Oncol 2010; 28: 1011–1016.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Gale R, Hills R, Wheatley K, Burnett A, Linch D . Response: still a need for more robust evidence that FLT3/ITD status should be influence the decision to proceed to transplantation in AML patients. Blood 2007; 109: 2265.

    Article  CAS  Google Scholar 

  56. Horowitz MM . High-resolution typing for unrelated donor transplantation: how far do we go? Best Pract Res Clin Haematol 2009; 22: 537–541.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Basara N, Schulze A, Wedding U, Mohren M, Gerhardt A, Junghanss C et al. Early related or unrelated haematopoietic cell transplantation results in higher overall survival and leukaemia-free survival compared with conventional chemotherapy in high-risk acute myeloid leukaemia patients in first complete remission. Leukemia 2009; 23: 635–640.

    Article  CAS  PubMed  Google Scholar 

  58. Schlenk RF, Dohner K, Mack S, Stoppel M, Kiraly F, Gotze K et al. Prospective evaluation of allogeneic hematopoietic stem-cell transplantation from matched related and matched unrelated donors in younger adults with high-risk acute myeloid leukemia: German-Austrian trial AMLHD98A. J Clin Oncol 2010; 28: 4642–4648.

    Article  PubMed  Google Scholar 

  59. Wagner JE . Should double cord blood transplants be the preferred choice when a sibling donor is unavailable? Best Pract Res Clin Haematol 2009; 22: 551–555.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Storb R . Reduced-intensity conditioning transplantation in myeloid malignancies. Curr Opin Oncol 2009; 21 (Suppl 1): S3–S5.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Gyurkocza B, Storb R, Storer BE, Chauncey TR, Lange T, Shizuru JA et al. Nonmyeloablative allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia. J Clin Oncol 2010; 28: 2859–2867.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Mohty M, de Lavallade H, Ladaique P, Faucher C, Vey N, Coso D et al. The role of reduced intensity conditioning allogeneic stem cell transplantation in patients with acute myeloid leukemia: a donor vs no donor comparison. Leukemia 2005; 19: 916–920.

    Article  CAS  PubMed  Google Scholar 

  63. Estey E, de Lima M, Tibes R, Pierce S, Kantarjian H, Champlin R et al. Prospective feasibility analysis of reduced-intensity conditioning (RIC) regimens for hematopoietic stem cell transplantation (HSCT) in elderly patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). Blood 2007; 109: 1395–1400.

    Article  CAS  PubMed  Google Scholar 

  64. Gooley TA, Chien JW, Pergam SA, Hingorani S, Sorror ML, Boeckh M et al. Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med 2010; 363: 2091–2101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Brunstein CG, Fuchs EJ, Carter SL, Karanes C, Costa LJ, Wu J et al. Alternative donor transplantation: results of parallel phase II trials using HLA-mismatched related bone marrow or unrelated umbilical cord blood grafts. Blood 2011; 118: 282–288.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Pagel JM, Gooley TA, Rajendran J, Fisher DR, Wilson WA, Sandmaier BM et al. Allogeneic hematopoietic cell transplantation after conditioning with 131I-anti-CD45 antibody plus fludarabine and low-dose total body irradiation for elderly patients with advanced acute myeloid leukemia or high-risk myelodysplastic syndrome. Blood 2009; 114: 5444–5453.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Warren EH, Fujii N, Akatsuka Y, Chaney CN, Mito JK, Loeb KR et al. Therapy of relapsed leukemia after allogeneic hematopoietic cell transplantation with T cells specific for minor histocompatibility antigens. Blood 2010; 115: 3869–3878.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Brune M, Castaigne S, Catalano J, Gehlsen K, Ho AD, Hofmann WK et al. Improved leukemia-free survival after postconsolidation immunotherapy with histamine dihydrochloride and interleukin-2 in acute myeloid leukemia: results of a randomized phase 3 trial. Blood 2006; 108: 88–96.

    Article  CAS  PubMed  Google Scholar 

  69. Konopleva MY, Jordan CT . Leukemia stem cells and microenvironment: biology and therapeutic targeting. J Clin Oncol 2011; 29: 591–599.

    Article  PubMed  PubMed Central  Google Scholar 

  70. de Lima M, Giralt S, Thall PF, de Padua Silva L, Jones RB, Komanduri K et al. Maintenance therapy with low-dose azacitidine after allogeneic hematopoietic stem cell transplantation for recurrent acute myelogenous leukemia or myelodysplastic syndrome: a dose and schedule finding study. Cancer 2010; 116: 5420–5431.

    Article  CAS  PubMed  Google Scholar 

  71. Cortes J, Perl A, Smith C, Kovacsovics T, Dombret H, Dohner H et al. A phase II open-label, AC220 Monotherapy Efficacy (ACE) Study in patients with Acute Myeloid Leukemia (AML) with FLT3-ITD activating mutations: interim results [abstract]. The 16th Congress of the European Hematology Association 2011, London. Ferrata-Storti Foundation: Pavia, Italy.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Washington Medical Center, Seattle, WA, USA

    E H Estey

  2. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    E H Estey

Authors
  1. E H Estey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E H Estey.

Ethics declarations

Competing interests

The author declares no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Estey, E. How to manage high-risk acute myeloid leukemia. Leukemia 26, 861–869 (2012). https://doi.org/10.1038/leu.2011.317

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/leu.2011.317

Keywords

This article is cited by

Search

Advanced search

Quick links