[Role of aggressive treatment strategies for XXXX ].

@entity1 @entity2590 @entity3052 @entity236 @entity790
@entity2590 ( @entity2590 ) constitute a heterogenous group of acquired @entity236 characterized by ineffective hematopoiesis, cellular dysfunction and an increased risk of transformation into @entity3052 ( @entity3052 ). The percentage of medullary blast cells and the karyotype at diagnosis are the most important predictors of survival. @entity1 with more than 10% blast cells or an unfavourable karyotype (chromosome 7 @entity790 ) usually survive less than 12 months. This review article focuses on the roles of intensive @entity3052 -type chemotherapy, autologous stem cell transplantation and allogeneic bone marrow transplantation in the management of @entity1 with advanced @entity2590 . Recent studies suggest that, with appropriate selection of @entity1 , intensive chemotherapy produces high rates of complete remission. Chances of entering remission are particularly high in @entity1 with a good Karnofsky score, bone marrow blast count < 30% and normal karyotype. When compared with @entity3052 , results of autologous bone marrow transplantation in @entity2590 are disappointing. A major disadvantage of this approach is the delayed recovery of hematopoiesis. Autologous peripheral blood progenitor cell transplantation overcomes this difficulty and is currently explored as consolidation therapy after successful remission induction with polychemotherapy in an intergroup study of the EORTC and EBMT. Allogeneic bone marrow transplantation remains the treatment of choice for younger @entity2590 @entity1 , offering a good chance of cure if the transplantation is performed at an early stage of disease or if the @entity1 receives the transplant in complete remission after conventional chemotherapy.
