A randomized study of the efficacy of consolidation therapy in adult acute nonlymphocytic leukemia

Abstract

The Eastern Cooperative Oncology Group conducted a randomized study to determine the efficacy of consolidation therapy in prolonging the duration of complete remission (CR) in adults with acute nonlymphocytic leukemia (ANLL). Induction chemotherapy with daunorubicin, cytosine arabinoside, and 6-thioguanine (DAT) yielded CR in 65% of 283 patients with ANLL, aged 16–69. For patients aged 60–69, the CR rate was 58%. Of 184 patients in CR, 146 patients were then randomized to receive either maintenance therapy with weekly cytosine arabinoside and 6-thioguanine alone (69 patients) or two courses of reduced doses of DAT 1 mo apart, before commencing the same maintenance program (77 patients). Consolidation therapy resulted in hematologic toxicity, but was not lethal in any of the eligible patients. Patients receiving consolidation plus maintenance therapy experienced a longer CR duration (40 wk) and disease-free survival at 2 yr (28%) than did those patients receiving maintenance therapy alone (34 wk and 14%, respectively). These differences are not statistically significant. These results suggest that approaches to consolidation therapy employing reduced doses of the induction therapy regimen can have, at best, only a small benefit. For consolidation therapy to provide substantial improvement in CR duration, intensive regimens with non-cross-resistant drugs will be required.

Long‐term survival of children with acute non‐lymphoblastic leukemia

“…Reports have correlated a poorer prognosis for ANLL patients with a diagnostic WBC over 100,000/mm3 [21], M4 and M5 subtypes [21], age over 16 years [33,34], lack of Auer rods [35], and time of greater than 2 months to enter remission [36]. We found no correlation of long-term survival with diagnostic WBC, histologic subtype, age, presence of Auer rods, or time to remit.…”

Temporal trends in the proportion cured among adults diagnosed with acute myeloid leukaemia in Sweden 1973–2001, a population‐based study

“…Improvements in the median survival time of ‘uncured’ reflect higher complete remission rates, which are likely to be due to more intense induction treatment and better management of short term toxicity (Pizzo et al , 1982; Segal & Freifeld, 2007; Boeckh & Ljungman, 2009; Cornely et al , 2009). The introduction of consolidation treatment (Cassileth et al , 1984; Preisler et al , 1987) has lowered the relapse rate, which, together with higher complete remission rates, is likely to explain a large part of the improvement in the cure proportion. Especially important was the introduction of high‐dose cytarabine consolidation treatment in the late 1980s (Schiller et al , 1992; Mayer et al , 1994), particularly for patients with core‐binding factor AML and normal cytogenetics (Bloomfield et al , 1998) but also the more frequent use of allo‐SCT in combination with lower TRM associated with SCT (Suciu et al 2003; Cornelissen et al , 2007; Meijer & Cornelissen, 2008).…”

Treatment of de novo acute myeloid leukaemia in Hong Kong: a twenty‐year experience (1975 to 1996)

“…highdose Ara-C) or bone marrow transplantation."' Studies, using standard dose Ara-C (1 00-200 mgi m'ldxscven to ten days) and daunorubicin for induction, followed by consolidation and maintenance3,6.1 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] reported median remission duration of nine to 18 months and projected longterm disease-free survival (DFS) of 20-30%. However, most of the clinical trials had relatively short follow-up.…”