In adult acute nonlymphoblastic leukaemia extended maintenance chemotherapy has no benefit

Abstract

Fifty-two consecutive and previously untreated adults with nonlymphoblastic leukaemia underwent remission induction chemotherapy with a combination of the epipodophyllotoxin VP16-213, cytosine arabinoside, and doxorubicin (Adriamycin). Complete remission was achieved in 23 of the 52 patients (44%) by means of a single course of therapy in 20 individuals, two courses in two, and three courses in one; median duration of complete remission was 48 weeks. Failure to achieve remission status was due to primary drug resistance in 13 patients (25%), and adequate trial of therapy was not possible in 16 patients (31%) owing to their late referral and accounts for the low remission rate. Individuals achieving complete remission were randomly assigned to receive either 6 (n = 8) or 15 months (n = 13) of maintenance therapy; respective median survival was 95 and 78 weeks (P greater than 0.10). These data confirm previously reported results for complete remission induction with this three-drug combination and fail to show any difference between short (6 months) and long (15 months) maintenance chemotherapy.

Pyoderma gangrenosum in myelodysplasia and acute leukaemia

“…Bone marrow aspiration and trephine showed extensive replacement with myeloblasts and a diagnosis of acute leukaemia was made. The patient achieved complete remission in response to cytosine arabinoside, doxorubicin, and VP16-213 (Jacobs et al, 1984), and after two courses of consolidation treatment entered a maintenance programme. The skin lesion healed completely, although slowly, over a period of 8 weeks (Figure 2) from commencing chemotherapy but recurred in the same site 16 months later when the patient relapsed.…”

Busulphan versus combination chemotherapy for initial treatment of chronic granulocytic leukaemia

“…Based on our experience that the combination of the epipodophyllotoxin VP16-2 13, cytosine arabinoside, and doxorubicin is effective in acute myeloblastic leukaemia [9], a pilot study was undertaken to compare its use to conventional treatment with busulphan in managing previously untreated adults in the stable phase of chronic granulocytic leukaemia. The objectives were to determine whether the emergence of blastic transformation could be delayed by the more aggressive three-drug combination regimen, and at the same time to establish whether disease control and survival were different.…”