Intensive postremission chemotherapy in Taiwanese adults with acute myelogenous leukemia
Intensive postremission chemotherapy has produced disease-free survival comparable to that of bone marrow transplantation in patients with acute myelogenous leukemia (AML), but its efficacy was unknown in Taiwan. We assessed the efficacy of intensive postremission chemotherapy, consisting of high-dose arabinoside-C (HiDAC) with or without transplantation of peripheral blood stem cells, in 33 AML patients from a single institute in Taiwan. Toxic reactions, treatment outcome, prognostic factors, and the size of the peripheral blood stem-cell harvest after HiDAC were analyzed. After a median follow-up of 21 months, 18 patients remained in continuous complete remission. The actuarial leukemia-free survival at 4 years was 51%. Relapse occurred in 12 patients, at a median of 12 months after initial diagnosis. All 6 patients with acute promyelocytic leukemia remained disease free after HiDAC therapy. Age, sex, and number of remission-induction or intensive consolidation chemotherapy courses had no effect on the risk of relapse. Intensive postremission chemotherapy can effectively prolong the duration of remission in young (<60 years of age) adults with AML.
Keywordsacute myelogenous leukemia postremission therapy high-dose arabinoside peripheral blood stem-cell transplantation
Champlin R, Gale R. Acute myelogenous leukemia: recent advances in therapy.Blood
1987;69: 1551–1562.PubMedGoogle Scholar
Rai KR, Holland JF, Glidewell OJ, et al. Treatment of acute myelogenous leukemia: a study by Cancer and Leukemia Group B.Blood
Bolwell BJ, Cassileth PA, Gale RP. High dose cytarabine: a review.Leukemia
. 1988;2:253–260.PubMedGoogle Scholar
Mayer RM, Davis RB, Schiffer CA, et al. Intensive postremission chemotherapy in adults with acute myelogenous leukemia.N Engl J Med.
Young JW, Papadopoulos EB, Cunningham I, et al. T-cell-depleted allogeneic bone marrow transplantation in adults with acute nonlymphocytic leukemia in first remission.Blood
. 1992; 79:3380–3387.PubMedGoogle Scholar
Bortin MM, Horowitz MM, Rowlings PA, et al. 1993 Progress report from the International Bone Marrow Transplant Registry.Bone Marrow Transplant
. 1993;12:97–104.PubMedGoogle Scholar
Phillips GL, Reece DE, Shepherd JD, et al. High-dose cytarabine and daunorubicin induction and postremission chemotherapy for the treatment of acute myelogenous leukemia in adults.Blood
. 1991;77:1429–1435.PubMedGoogle Scholar
Zittoun RA, Mandelli F, Willemze R, et al. Autologous or allogeneic bone marrow transplantation compared with intensive chemotherapy in acute myelogenous leukemia.N Engl J Med.
Bennett JM, Catovsky D, Daniel MT, et al. Proposals for the classification of acute leukemias.Br J Haematol
. 1976;33:451–458.PubMedCrossRefGoogle Scholar
Cheson BD, Cassileth PA, Head DR, et al. Report of the National Cancer Institute-sponsored workshop on definitions of diagnosis and response in acute myeloid leukemia.J Clin Oncol.
Hsu HC, Tsai WH, Lin JS, Tzeng CH, Wang SY, Ho CH. Primary transplantation of allogeneic peripheral blood stem cells for severe aplastic anemia.Ann Hematol.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations.J Am Stat Assoc.
Schiller G, Gajewski J, Territo M, et al. Long-term outcome of high-dose cytarabine-based consolidation chemotherapy for adults with acute myelogenous leukemia.Blood
. 1992;80: 2977–2978.PubMedGoogle Scholar
Cassileth PA, Harrington DP, Appelbaum FR, et al. Chemotherapy compared with autologous or allogeneic bone marrow transplantation in the management of acute myeloid leukemia in first remission.N Engl J Med.
Gray R, Wheatley K. How to avoid bias when comparing bone marrow transplantation with chemotherapy.Bone Marrow Transplant
. 1991;7(suppl 3):9–12.PubMedGoogle Scholar
Lowenberg B. Postremission treatment of acute myelogenous leukemia (editorial).N Engl J Med.
Wolff SN, Herzig RH, Fay JW, et al. High-dose cytarabine and daunorubicin as consolidation therapy for acute myeloid leukemia in first remission. Long-term follow-up and results.J Clin Oncol.
Mandelli F, Vegna ML, Avvisati G, et al. A randomized study of the efficacy of post-consolidation therapy in adult acute nonlymphocytic leukemia: a report of the Italian Cooperative Group GIMEMA.Ann Hematol
. 1992;64:166–172.PubMedCrossRefGoogle Scholar
Elonen E, Almqvist A, Hanninen A, et al. Comparison between four and eight cycles of intensive chemotherapy in adult acute myeloid leukemia: a randomized trial of the Finnish Leukemia Group.Leukemia
. 1998;12;1041–1048.PubMedCrossRefGoogle Scholar
Harousseau JL, Cahn JY, Pignon B, et al. Comparison of autologous bone marrow transplantation and intensive chemotherapy as postremission therapy in adult acute myeloid leukemia. The Groupe Ouest Est Leucemies Aigues Myeloblastiques (GOELAM).Blood
. 1997;90:2978–2986.PubMedGoogle Scholar
Stein AS, O’Donnell MR, Chai A, et al. In vivo purging with high-dose cytarabine followed by high-dose chemoradiotherapy and reinfusion of unpurged bone marrow for adult acute myelogenous leukemia in first complete remission.J Clin Oncol.
Fenaux P, Chastang C, Chevert S, et al. A randomized comparison of all trans-retinoic acid (ATRA) followed by chemotherapy and ATRA plus chemotherapy and the role of maintenance therapy in newly diagnosed acute promyelocytic leukemia.Blood
. 1999;94:1192–1200.PubMedGoogle Scholar
Tallman MS, Andersen JW, Schiffer CA, et al. All-trans retinoic acid in acute promyelocytic leukemia.N Engl J Med.
Estey E, Thall PF, Pierce S, Kantarjian H, Keating M. Treatment of newly diagnosed acute promyelocytic leukemia without cytarabine.J Clin Oncol.
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