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Long-term outcome of high-dose cytarabine-based consolidation chemotherapy
for adults with acute myelogenous leukemia
G Schiller, J Gajewski, M Territo, S Nimer, M Lee, T Belin and R Champlin
Department of Medicine, UCLA School of Medicine 90024-1678.
Modern induction chemotherapy produces 60% to 80% complete remissions in
adults with newly diagnosed acute myelogenous leukemia. A major challenge
is to eradicate subclinical disease in remission and prevent leukemic
relapse. We analyzed the long-term results of high-dose
cytarabine-anthracycline consolidation chemotherapy without maintenance
treatment and examined the effect of major prognostic factors, including
age, sex, history of preleukemia, and cytogenetics. Two hundred
twenty-seven patients with newly diagnosed acute leukemia were enrolled on
two sequential studies conducted from 1982 to 1991. One hundred fifty-one
patients (67%) achieved a complete remission. One hundred twenty-three
patients were eligible for high-dose cytarabine- based consolidation
administered in two to three courses. After a median follow-up of 4.8
years, 40 patients remain alive, with 28 in continued remission. Median
remission duration for all eligible patients is 12.8 months, and actuarial
leukemia-free survival (LFS) at 5 years is 26% +/- 8%. Advanced age and
male sex were negative prognostic indicators for LFS. For patients < or
= 45 years of age, 5- year LFS was 35% +/- 13%, as compared with 18% +/-
11% for patients greater than age 45 (P = .03). Toxicity of consolidation
chemotherapy included treatment-related death in nine patients and serious
neurotoxicity in five. Our results show an improved LFS for younger
patients treated with high-dose cytarabine-based consolidation. There was
no apparent benefit for older patients compared with reported data with
less intensive regimens.
Volume 80,
Issue 12,
pp. 2977-2982,
12/15/1992
Copyright © 1992 by The American Society of Hematology
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