The treatment of acute myelocytic leukemia in patients 30 years of age and younger

Abstract

The treatment of acute myelocytic leukemia in childhood and young adults has lagged behind that for acute lymphocytic leukemia. The studies described here were directed towards evaluating the role of intensive chemotherapy in the treatment of this illness. Intensive remission induction therapy combining cytosine arabinoside with an anthracycline antibiotic produced a complete remission rate comparable to that achieved in acute lymphocytic leukemia (45 of 49 patients or 92%). Intensive consolidation chemotherapy produced a median duration of complete remission of 160 weeks with 40% of patients projected to be in remission at 4 years. By contrast, the median duration of remission for patients treated with moderate consolidation/maintenance therapy was 23 weeks with only 10% of patients in remission at 4 years. These studies demonstrate that intensive chemotherapy can be administered to pediatric patients and young adults and that this approach to therapy produces a high remission rate with a 3 year median duration of remission.

Bone marrow transplantation for leukaemia.

“…The best overall results from chemotherapy protocols have been in unrandomised, often single centre studies with event free survival of 30-40%. [17][18][19] Survival rates in small series of children with acute myeloid leukaemia from the time of marrow transplantation in first remission are in the order of 65%.2( 21 The failures in the chemotherapy reports are largely due to relapse, and those in the series of bone marrow transplantation due to transplant related deaths. There is a continuing debate, reviewed elsewhere,'5 between the proponents of bone marrow transplantation in first remission for children with acute myeloid leukaemia and a donor, and chemotherapy with bone marrow transplantation at the first sign of relapse.…”

Prediction of response of patients with acute nonlymphocytic leukaemia to remission induction therapy: use of clinical measurements

“…A bone marrow biopsy was performed after 6 d of therapy and if the cellularity was < 50% the araC was continued at 100 mg/m2/d to complete a 10 d course of therapy. If the effects of the first 6 d of therapy was minimal so that the cellularity of the day 6 biopsy was > SO%, augmentation therapy was administered consisting of cytosine arabinoside (araC) at 3 g/m2 q 12 h on days 8 , 9 and 10 instead of the standard dose of 100 mg/m2/d on days 8-10 (Preisler et al, 1982). Thirty-one patients actually reccived 'augmentation' therapy and of these the marrow cellularity was > SO% in 20 patients, it was < 50% in seven patients, and was inevaluable in four patients.…”

High-dose cytosine arabinoside and daunorubicin postremission therapy in adults with de novo acute myeloid leukemia

“…Intensified CT using potent antileukemic drugs in maximum concentrations to eradicate residual leukemic blasts in CR might increase the median survival and cure rate in AML. Preliminary data on high dose cytosine arabinoside (HD-Ara-C)-based post-remission therapy had produced encouraging results in terms of disease-free survival in patients not undergoing allogeneic or autologous BMT [9,10]. These promising results prompted us to use an HD-Ara-C-based regimen in combination with daunorubicin for consolidation therapy in de novo AML patients.…”

“…A variety of approaches have been employed to prolong remission duration, including long-term maintenance therapy, additional intensive CT (consolidation) with or without subsequent maintenance therapy, or no further therapy (for review see [1][2][3]). Despite these efforts, the majority of AML patients relapse after a remission duration of [8][9][10][11][12][13][14][15][16][17][18] months, and only 20-30% survive free of recurrence at 5 years and are probably cured (for review see [2M]). As a consequence, new concepts of CT for AML patients who are not candidates for allogeneic bone marrow transplantation (BMT), which has proved to be the most effective post-remission strategy [5][6][7][8], were introduced.…”