Is there a role for intensifying induction therapy in acute myeloid leukaemia (AML)?

Intensifying induction is not a new concept, but some recent and emerging information suggests that intensifying induction may be a relevant strategy for both young and older patients with acute myeloid leukaemia (AML). There are several potential strategies for intensifying induction therapy, including modulation of anthracyclines; modulation of ara-C; addition of other agents, including high-dose ara-C (HiDAC); addition of targeted or immunomodulatory agents, including gemtuzumab ozogamicin; or using timed-sequential therapy or very early intensification. It is clear that daunorubicin at a 45 mg m−2 dose is no longer acceptable as the standard for induction therapy in AML, but the optimal dose is unknown. No anthracycline dose attenuation should be made for older, fit adults, and modulation of induction can lead to significant survival benefit even without improving the initial response rate.