Strategies to Develop Less Toxic Induction Regimens Intensive induction chemotherapy is recommended for all patients who’re fit to tolerate it. No patients with 5q removal were among the responders, but all responders had low blast counts at diagnosis. Apparently, 2 of 4 patients who had relapsed after an allogeneic stem cell transplant designed acute graft versus host disease of the skin and tough CR. Toxicities involved infection and fatigue, but high dose lenalidomide was relatively well accepted. SWOG Cathepsin Inhibitor 1 conducted a phase II clinical trial for untreated elderly patients with 5q removal with or without additional cytogenetic abnormalities. Thirty seven patients were enrolled. Treatment contains one cycle of lenalidomide induction at 50 mg daily for 28 days, followed closely by preservation lenalidomide at 10 mg daily for 21 days of a 28 day cycle. Only 14 patients accomplished induction and 8 proceeded to maintenance treatment. Results were disappointing with deaths during induction, progression on treatment and other adverse events precluding achievement of in the pipeline therapy. Fourteen percent of patients achieved PR or CR and over all survival was 2 weeks for many patients. Another phase II trial in 33 untreated patients with AML by Fehniger, et al enrolled patients over age 60 and similarly used lenalidomide at Cholangiocarcinoma 50 mg daily for 28 days as induction therapy. In this trial, patients were able to be given a 2nd 28-day induction pattern at 50 mg. Those with CR or CRi or these not progressing after 2 cycles of induction could proceed onto low-dose lenalidomide at 10 mg daily for a maximum of 12 cycles. In this study, the CR/CRi rate was 53% for patients completing induction therapy, with higher rates of CR noticed in patients with lower boost counts at presentation. Median length of CR was 10 months. These disparate clinical outcomes from two very small phase II studies suggest the necessity for larger studies to determine the effectiveness of high-dose lenalidomide in patients with AML. Continuous studies include Lonafarnib SCH66336 lenalidomide in conjunction with hypomethylating other chemotherapy drugs and brokers at varying doses. Clofarabine is a novel nucleoside analogue first learned in relapsed and refractory leukemia. Recent studies have showed responses to single agent clofarabine, in addition to in combination with chemotherapy, in untreated elderly people or those unfit for conventional induction. Inside the CLASSIC II study, adults age 60 with untreated AML and at least one extra unfavorable prognostic feature were enrolled. As induction followed by consolidation cycles at 20 mg/m2/day 5 days for no more than 6 cycles clofarabine was given as a single representative at 30 mg/m2/day 5 days. The CR/CRi rate was 46-room and those with greatest responses had the longest survival with median OS for the complete cohort of 41 weeks, 59 weeks for those with CR/CRi and 72 weeks for those achieving CR. Responses were observed in all cytogenetic risk groups.