Annals of Hematology

, Volume 71, Issue 5, pp 219–225 | Cite as

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

Long-term follow-up of a prospective multicenter trial
  • G. Heil
  • P. S. Mitrou
  • D. Hoelzer
  • M. Freund
  • H. Link
  • G. Ehninger
  • B. Steinke
  • S. Öhl
  • H. Wandt
  • E. Fackler-Schwalbe
  • G. Schlimok
  • A. Lösch
  • W. Queißer
  • B. Löffler
  • W. Gaus
  • J. Högel
  • H. Heimpel
  • E. Kurrle
Original Article

Abstract

A total of 149 consecutive de novo AML patients aged 50 years or less (median age = 37 years) were enrolled in this prospective multicenter trial initiated in May 1985. All patients received the same induction and early consolidation therapy with daunorubicin (DNR), cytosine arabinoside (Ara-C), and etoposide (DAV). High-dose Ara-C/DNR therapy included Ara-C at 3 g/m2, in 12 doses (HD-Ara-C/DNR I) and eight doses (HD-Ara-C/DNR II), followed by DNR 30 mg/m2 for 3 days. A complete remission (CR) was achieved in 104 (70%) patients; 61 complete responders received at least one cycle with HD-Ara-C/DNR. If those patients who were transplanted in first CR (n=26), were not considered, the median relapsefree-survival (MRFS) of the remaining 78 patients was 15 months, with a probability of relapse-free survival (RFS) at 116 months of 30% (95% CI, 20–40%) after a median follow-up of 95 months. The MRFS of the HD-Ara-C/DNR consolidated patients was 25 months, with a probability of RFS at 116 months of 37% (95% CI, 24–50%). If all patients who were transplanted (n=44) were not considered, the median survival time (MST) was 18 months with a probability of being alive at 118 months of 24% (95% CI, 16–33%). MST of the HD-Ara-C/DNR consolidated patients was 58 months with a survival probability of 46% (95% CI, 31–60%) at 118 months. Prognostic factor analysis did not reveal any significant influence of age, sex, FAB subtype, white blood cell count, hemoglobin level, thrombocyte count, LDH, or response to the first induction course on RFS of the HD-Ara-C/DNR consolidated patients. In summary, HD-Ara-C/DNR consolidation can improve the long-term outcome of a subgroup of de novo AML patients. Further improvement of the outcome seems to depend on the identification of patients with an inferior outcome under that strategy who might benefit from alternative treatment strategies.

Key words

De novo AML Adults HD-Ara-C/DNR consolidation 

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Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • G. Heil
    • 1
  • P. S. Mitrou
    • 2
  • D. Hoelzer
    • 2
  • M. Freund
    • 3
  • H. Link
    • 3
  • G. Ehninger
    • 4
  • B. Steinke
    • 4
  • S. Öhl
    • 5
  • H. Wandt
    • 5
  • E. Fackler-Schwalbe
    • 6
  • G. Schlimok
    • 6
  • A. Lösch
    • 7
  • W. Queißer
    • 7
  • B. Löffler
    • 8
  • W. Gaus
    • 9
  • J. Högel
    • 9
  • H. Heimpel
    • 1
  • E. Kurrle
    • 1
  1. 1.Department of Internal Medicine IIIUniversity of UlmUlmGermany
  2. 2.Department of Haematology/OncologyUniversity of FrankfurtGermany
  3. 3.Department of Haematology/OncologyUniversity of HannoverGermany
  4. 4.Department of HaematologyUniversity of TübingenGermany
  5. 5.Department of Internal Medicine and Institut for Medical Oncology/HaematologyNürnbergGermany
  6. 6.Department of Internal MedicineZentralklinikum AugsburgGermany
  7. 7.Department of OncologyKlinikum MannheimGermany
  8. 8.Department of Internal MedicineRobert-Bosch-KrankenhausStuttgartGermany
  9. 9.Department of Biometry and Medical DocumentationUniversity of UlmGermany

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