High intensity therapy

Chemotherapy

• AML-type chemotherapy should be considered in patients <60 years with relatively high risk disease and good performance status (high risk IPSS/RAEB or RAEB-t); responses lower (40-50%) and treatment related morbidity and mortality higher than de novo AML; age >50 and karyotypic abnormalities associated with poor response.

• 5-aza-2-deoxycytidine achieved 64% responses in patients with high risk IPSS scores; myelosuppressive; requires hospitalisation; phase III trials under way.

High dose therapy

• Sibling allogeneic SCT offers the best prospect of prolonged survival and possible cure (35-40% 3 year DFS); few eligible but treatment of choice for patients aged <50 with >IPSS intermediate-1 and sibling donor; high treatment related mortality (>40%); relapse rate up to

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