Chemotherapy for patients with acute myeloid leukemia in first remission
- 59 Downloads
Although the majority of patients with acute myeloid leukemia (AML) achieve a complete remission with induction chemotherapy, most will ultimately relapse. Therefore, the optimal postremission therapy for AML remains to be defined, and further improvements in treatment strategies are required. Clinical trials have demonstrated that early intensive consolidation therapy with high-dose cytarabine can produce prolonged responses in up to 40% of patients in remission after standard induction therapy. Equally, however, it has been shown that high-dose cytarabine used in induction therapy can deliver equivalent long-term results. Autologous and allogeneic stem cell transplantation in first remission are also valid alternatives, but the value of low-dose maintenance treatment seems confined to acute promyelocytic leukemia. Further improvement in the treatment of AML is likely to depend on the development of new strategies, such as molecularly targeted or immune therapies.
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 13.Moore JO, George SL, Dodge RK, et al.: Sequential multiagent chemotherapy is not superior to high-dose cytarabine alone as postremission intensification therapy for acute myeloid leukemia in adults under 60 years of age: Cancer and Leukemia Group B Study 9222. Blood 2005, 105:3420–3427. Study confirming the unique importance of high-dose cytarabine in consolidation therapy.PubMedCrossRefGoogle Scholar
- 17.Bradstock KF, Matthews JP, Lowenthal RM, et al.: A randomized trial of high-versus conventional-dose cytarabine in consolidation chemotherapy for adult de novo acute myeloid leukemia in first remission after induction therapy containing high-dose cytarabine. Blood 2005, 105:481–488. Trial prospectively examining the value of high-dose cytarabine in consolidation after intensive induction chemotherapy.PubMedCrossRefGoogle Scholar
- 20.Zittoun RA, Mandelli F, Willemze R, et al.: Autologous or allogeneic bone marrow transplantation compared with intensive chemotherapy in acute myelogenous leukemia. European Organization for Research and Treatment of Cancer (EORTC) and the Gruppo Italiano Malattie Ematologiche Maligne dell’Adulto (GIMEMA) Leukemia Cooperative Groups. N Engl J Med 1995, 332:217–223.PubMedCrossRefGoogle Scholar
- 24.Burnett AK, Wheatley K, Goldstone AH, et al.: Medical Research Council Adult and Paediatric Working Parties: The value of allogeneic bone marrow transplant in patients with acute myeloid leukemia at differing risk of relapse: results of the UK MRC AML 10 trial. Br J Haematol 2002, 118:385–400. Analysis of the impact of allogeneic transplantation in first complete remission in a large patient cohort.PubMedCrossRefGoogle Scholar
- 25.Giralt S, Estey E, Albitar M, et al.: Engraftment of allogeneic hematopoietic progenitor cells with purine analog-containing chemotherapy: harnessing graft-versus-leukemia without myeloablative therapy. Blood 1998, 91:756–763.Google Scholar
- 29.Buchner T, Hiddemann W, Berdel WE, et al.: 6-Thioguanine, cytarabine, and daunorubicin (TAD) and high-dose cytarabine and mitoxantrone (HAM) for induction, TAD for consolidation, and either prolonged maintenance by reduced monthly TAD or TAD-HAM-TAD and one course of intensive consolidation by sequential HAM in adult patients at all ages with de novo acute myeloid leukemia: a randomized trial of the German AML Cooperative Group. J Clin Oncology 2003, 21:4496–4504.CrossRefGoogle Scholar
- 30.Brune M, Castaigne S, Catalano J, et al.: Improved leukemiafree survival after post-consolidation treatment with histamine dihydrochloride and interleukin-2 in AML: a randomized phase III trial [abstract]. Blood 2004, 104:Abstract 261.Google Scholar
- 31.Fenaux P, Chastang C, Chevret S, et al. for the European APL Group: A randomized comparison of all transretinoic acid (ATRA) followed by chemotherapy and ATRA plus chemotherapy and the role of maintenance chemotherapy in newly diagnosed acute promyelocytic leukemia. Blood 1999, 94:1192–1200. Trial that established the role for maintenance therapy in APL after ATRA-based induction.PubMedGoogle Scholar