Sequential therapy for induction and maintenance of remission in acute myeloblastic leukemia

Abstract

A total of 114 previously untreated patients with myeloblastic leukemia was included in a sequential therapy protocol. Daunorubicin, vincristine, and prednisone were employed for the first 3 weeks, followed by two or more 5‐day courses of cytosine arabinoside and 6‐mercaptopurine; there was a 5‐day rest between courses. Maintenance therapy was as follows: the continuing 6‐mercaptopurine and methotrexate treatment was interrupted every 30 days for sequential reinforcement courses consisting of one dose of daunorubicin and vincristine and 7 days of prednisone, or by a 5‐day course of cytosine arabinoside plus 6‐mercaptopurine. Of the 114 patients, 48 obtained complete remission, 14 had partial remission, 16 failed to respond, and 36 died during the course of treatment. The remission rate in children (under 16) was 57%; in adults (16–45) 54%; and in those over 45, 19%. The difference in the incidence of complete remission in patients under 45 and those over 45 was statistically significant (p < 0.01). The median duration of complete remission was 8 months: 12 months in children and 5 months in adults. The over‐all survival rate was 4 months: 13 months for patients with complete remission, 4 months for those with partial remission, and 1 month for patients who did not respond to therapy. The difference in survival of those with complete remission and all the others was significant (p < 0.01).

Acute nonlymphocytic leukemia in 171 children

“…Eppinger-Helft et al The observation that survival duration is longer in patients responding to chemotherapy is universal. For patients who attained at least one complete remission, the median survival in the AML-68 (12 months) and the AML-70 (16 months) studies is of the same order as the 10-19 months reported by others (20,21,24,28,33,38,39,42). Some reports suggest that the addition of immunotherapy may produce longer survivals (28,41).…”

“…Complete remission was induced in 57 of 86 previously untreated patients (66%) who entered studies in 1968-1973 with no significant differences between the 3 regimens (Table V). This frequency, although better than the 34% (21) to 38% (26) in series spanning many years, is of the same order as the 50-65% attained in the more successful studies of adults (20,26,(28)(29)(30)(31)(32) and the 42-57% in children reported by the Argentine Study Group (33,43). In fact, if one excludes the early deaths in this series the frequency of remission changes little (68%), while in adults the percentage improves by about 20% (26,28).…”

“…Bernard et al (43) reported a 26month median duration of remission in patients with APML. Among adults, remission durations tend to be shorter with increasing age (24,33). In at least one study in which treatment was uniform (33) remission durations were shorter in adults than in children.…”

“…While the actual frequencies span a broad range, there is general agreement that CNS leukemia is diagnosed more often in ALL than in ANLL (34,(47)(48)(49) and more often in children than in adults with either cell type (28,33,34,47,50). Among adults with ALL, however, the frequency of CNS leukemia may not differ with age (49).…”

Remission Maintenance Therapy for Meningeal Leukaemia: Intrathecal Methotrexate and Dexamethasone versus Intrathecal Craniospinal Irradiation with a Radiocolloid

“…The analysis of duration of remission was done on I August 1975. All these patients were treated systemically according to protocols recently published (Pavlovsky et al, 1973a;Sackniann Muriel ct al, 1974;Eppinger-Helft et al, 1975). Previous therapy for meningeal leukaemia or preventive CNS irradiation did not disqualify patients from this study.…”