Short-term therapy for acute myelogenous leukemia.

Abstract

Since 1978, 187 patients (age range, 15 to 59, median 44 years) have received short-term chemotherapy as part of three sequential open studies (B-IX, X, Xb) or a randomized clinical trial (B-XI). An intended six cycles of Adriamycin (ADR) (doxorubicin; Adria Laboratories, Columbus, OH), cytarabine (ara-C), and thioguanine (TG) were administered with as short an intercycle time as possible. No further therapy was administered. Complete remission (CR) was achieved in 118 of 187 patients (63%). On univariate and multivariate analyses achievement of CR correlated adversely with a low serum albumin at presentation and an antecedent marrow disorder. Forty-five patients continue in first remission between 15 months and 8 1/2 years, no relapses being seen after 3 1/2 years (median follow-up, 3 1/2 years). The median duration of remission was 1 year. M3 morphology, a blast count less than 100 x 10(9)/L, and absence of hepatosplenomegaly correlated favorably with remission duration. There was no difference in duration of remission between patients receiving 3, 4, 5, or 6 cycles. The best results overall were achieved in patients under the age of 40, with 43% projected to remain free of disease at 5 years. Fifty patients remain alive between 17 months and 9 years, the predicted actuarial survival being 25% at 5 years.

BU/melphalan and auto-SCT in AML patients in first CR: a ‘Gruppo Italiano Trapianto di Midollo Osseo (GITMO)’ retrospective study

“…1 However, the majority relapses without any further post-remission treatment. Therefore, post-remission therapeutic strategies have been progressively intensified, [2][3][4] including high-dose chemotherapy followed by infusion of allogeneic or autologous stem cells. The role of auto-SCT in the treatment of patients with AML in first CR remains unsettled.…”

“…The role of auto-SCT in the treatment of patients with AML in first CR remains unsettled. Although allo-SCT is considered the most effective anti-leukemic treatment available for young patients with high-risk AML in first CR, 1,2 there is a certain degree of controversy on the best therapeutic approach for other patient populations. The results from early phase III trials have generally shown that auto-SCT results in a lower relapse rate than conventional chemotherapy that results in a modest improvement in the disease-free survival (DFS).…”

High-dose cytosine arabinoside plus etoposide as initial treatment for acute myeloid leukaemia: a single centre study

“…The toxicity of Ara-C and etoposide is shown in Table IV. (Hurd, 1987;Powles et al, 1980a;Mayer, 1987;Preisler et al, 1987a;Cassileth et al, 1987;Rohatiner et al, 1988). This is partly attributable to lack of matched sibling donors for many patients, increased drug toxicity in the elderly, and a high incidence of relapse particularly in FAB subtypes with a monocytic component (Hurd, 1987;Mayer et al, 1987;Peterson et al, 1987).…”

“…These results, however, depend upon obtaining remission, higher CR rates rendering more patients eligible for a bone marrow transplant procedure (Powles et al, 1980a). Recent clinical trials using various combinations of drugs including anthracyclines have not resulted in significantly improved remission rates, and have usually involved protracted treatment (Mayer, 1987;Preisler et al, 1987a;Cassileth et al, 1987;Capizzi et al, 1987;Rohatiner et al, 1988). Treatment-related morbidity is thus increased, with the attendant financial burdens of hospitalisation, together with continued requirement for blood product and antibiotic support. Etoposide is effective in the treatment of acute leukaemia (AL) (Gore et al, 1989;O'Dwyer et al, 1985), and preclinical trials have shown it to be synergistic when used in conjunction with Ara-C (Rivera et al, 1975).…”

Acute Myelogenous Leukemia Relapsing as Granulocytic Sarcoma of the Cervix

“…33 With modern chemotherapy regimens, the initial response rate is 60-65% for all patients, with a median duration of remission of 18-24 months and 20% remaining disease free for up to 12 years. 9,39 The complete response rate for identically treated patients older than 60 is < 50%.…”