ABSTRACT
PURPOSE: Important advances in the treatment of acute myelogenous leukemia have been made with the introduction of cytosine arabinoside(ara-C) and anthracycline(daunorubicin) over the past 20 years. Currently, 50 to 85% of patients with acute myelogenous leukemia achieve complete remission with induction chemotherapy consisting of ara-C and daunorubicin. About 25% of complete responders will have extended long-term survival and may be cured. Therefore we treated patients having acute myelogenous leukemia with AD(7+3) regimen and analyzed factors complete remission rate, remission duration, and survival duration. MATERIALS AND METHODS: Induction therapy; Thirty seven patients with previously untreated acute myelogenous leukemia treated with AD(7+ 3) regimen(ara-C, 200 mg/m2/d by continuous infusion for seven days, and daunorubicin, 45 mg/m2/d for 3 days). The second course of therapy was AD(5+2), if the patients failed to enter remission. Consolidation therapy; three cycles of consolidation chemotherapy were administrated with at least 4 week interval following remission. Course 1; ara-C at 100 mg/m2 by continuous infusion every 12 hour for five days, 6-thioguanine at 100 mg/m2/day orally for 5 days. Course 2; ara-C is same as course 1, vincristine at 1.2 mg/m2(maximum 2 mg) by bolus injection for 1 day, prednisolone at 40 mg/m'(maximum 60 mg) orally for 5 days. Course 3; ara-C is same as course 1, daunorubicin at 45 mg/m2 by 1 hour infusion for 2 days. RESULT: 62.2 percent of the 37 patients entered complete remission. The remission duration for all patients in complete remission ranged from 2 months to 63+ months, with the median of 15.1 months. The median duration of survival in complete responder group was 23.3 months. Among various prognostic factors, females and groups with normal chromosome and t(8;21) or t(15;17) had significantly higher complete remission rate than males and groups with other chromosomal abnormalities, respectively. Factors influencing on survival duration were female, normal chromosome, t(8;21) or t(15;17), Auer rod-positive, and peripheral blast % less than 50% at diagonosis. Groups with Auer rod-positive, normal chromosome, and t(8;21) or t(15;17) also had significantly longer remission duration. CONCLUSION: Combination chemotherapy with cytosine arabinoside and daunorubicin is a effective regimen for acute myelogenous leukemia as much as other regimen for acute myelogenous leukemia. Further clinical trials for effective treatment regimen are necessary to increase the complete remissioin rate.
Subject(s)
Female , Humans , Male , Chromosome Aberrations , Consolidation Chemotherapy , Cytarabine , Cytosine , Daunorubicin , Drug Therapy, Combination , Induction Chemotherapy , Leukemia , Leukemia, Myeloid, Acute , Prednisolone , Thioguanine , VincristineABSTRACT
PURPOSE: Important advances in the treatment of acute myelogenous leukemia have been made with the introduction of cytosine arabinoside (ara-C) and anthracyclines (daunorubicin) over the past 20 years. Currently, 60 to 80% of patients with acute myelogenous leukemia achieve complete remission with induction chemotherapy consisting of ara-C and daunorubicin (adriamycin) AD ("7+3"). The one-fourth of complete responders will have extended long-term survival and may be cured. Therefore wetreated patients with acute myelogenous leukemia admitted to our hospital with AD ("7+3") regimen. METHODS: Induction therapy; Thirty four patients with previously untreated acute myelogenous leukemia received AD ("7+3") regimen (ara-C, 200 mg/m2/d by continuous infusion for seven days, and daunorubicin, 45 mg/m2/d for 3 days). The second course of therapy was AD ("5+2"), if the patients failed to enter remission. Consolidation therapy; three cycles of consolidation chemotherapy were administered with at least 4 week interval following remission. Course 1; ara-C at 100 mg/m2 by subcutaneous injection every 12 hour for seven days, 6-thioguanine at every 12 hour 100 mg/m2 orally every 12 hour for 7 days). Course 2; ara-C (same as course 1) at 100 mg/m2 by subcutaneous injection every 12 hour for seven days, vincristine at 1.5 mg/m2 (maximum 2 mg) by bolus injection for 1 day, prednisolone at 40 mg/m2 (maximum 60 mg) orally for 7 days. Course 3; ara-C (same as course 1) daunorubicin at 45 mg/m2 by 1 hour infusion for 3 dyas. RESULTS: Sixty-eight percent of the 34 patients entered complete remission. The remission duration for all patients in complete remission ranged from 4 weeks to 3122+ weeks, with the median of 50 weeks. The median duration of survival in complete responder group was 62 weeks. Twenty-Six percent of patients with complete remission are alive at 5 years. Cases with extramedullary leukemic involvement were found in four patients; M2 with orbital mass, M3 and M4 with CNS leukemia, M5a with subcutaneous nodules. Among the potential prognostic variables including age, initial WBC count, percent of blast in peripheral blood,none was statistically related to prognosis. CONCLUSION: Combination chemotherapy with cytosine arabinoside and daunorubicin is a effective regimen for acute myelogenous leukemia as much as other regimen. Futher clinical trials for effective treatment regimen and method are necessary to raise the complete remission rate.