If unilateral testicular involvement is clinically evident, the apparently uninvolved testis should undergo biopsy. Treatment is by irradiation of involved testes and administration of systemic reinduction therapy as for isolated CNS relapse. The FAB classification alone does not predict response. Failure to achieve remission can be related to death or drug resistance from infection or bleeding during the period of hypoplasia. Patients with secondary AML have a poor prognosis.
Initial therapy aims at inducing remission.
Treatment differs most from ALL in that AML responds to fewer drugs. Some regimens include 6-thioguanine, etoposide, vincristine, and prednisone, but their contribution is unclear. Treatment usually results in significant myelosuppression, often for long periods before marrow recovery. CNS prophylaxis is usually not given because, with better systemic disease control, CNS leukemia is a less frequent complication. Maintenance therapy has no demonstrated role in AML patients who have had intensification treatment.