[en] BACKGROUND: In 1985, the authors published a study of acute myelogenous leukemia (AML) patients treated with a chemotherapeutic regimen that was then considered intensive. Ten years later, the authors reanalyzed the same cohort to determine whether the very promising actuarial results observed at 5 years held after longer follow-up. METHODS: Between 1977 and 1982, 61 patients with AML were treated with a protocol consisting of daunorubicin, vincristine, and cytosine arabinoside induction followed by consolidation and maintenance for a total of 2 years. The complete remission (CR) rate was 66%, 84% in males versus 47% in females (P < 0.005). At the time of the first analysis in 1984, the overall survival (OS) was 17%, the projected 5-year continuous CR rate (CCR) 32%, and the disease free survival (DFS) rate 29%, with the best results observed for males and for patients ages 40-60 years (P < 0.05). RESULTS: When the data were reanalyzed 11 years later in 1995, the results were 14% OS, 23% CCR, and 16% DFS at 5 years. However, these figures dropped to 8%, 18%, and 11% at 10 years and to 8%, 12%, and 7% at 15 years, respectively. Among the 40 CR patients, 31 relapsed (up to 13 years after CR), and all died within 1.6 years after relapse. Nine patients were in CCR: 4 died of unrelated causes (suicide, alcoholic cirrhosis, acute peritonitis, or bladder carcinoma), 1 was lost to follow-up after 11 years, 2 were alive and well at 17 years at last follow-up, and 2 were transplanted in first CR and were doing well at 13 and 14 years at last follow-up. The survival advantage for males over females persisted (P = 0.0197), but the advantage for patients age 40-60 years did not hold. CONCLUSIONS: These long term data indicate that actuarial analysis at 5 years may overestimate the cure rate of AML patients because a number of late relapses do occur. However, the picture is blurred by the incidence of death not related to leukemia or its treatment; and when these patients were censored at the time of death, 17% of CR patients were still projected to be alive and free of leukemia after 17 years.
Disciplines :
Hematology
Author, co-author :
Beguin, Yves ; Centre Hospitalier Universitaire de Liège - CHU > Hématologie clinique
Sautois, Brieuc ; Centre Hospitalier Universitaire de Liège - CHU > Oncologie médicale
Forget, Patricia ; Centre Hospitalier Universitaire de Liège - CHU > Pédiatrie CHR
Bury, Jean
Fillet, Georges ; Centre Hospitalier Universitaire de Liège - CHU > Hématologie clinique
Language :
English
Title :
Long term follow-up of patients with acute myelogenous leukemia who received the daunorubicin, vincristine, and cytosine arabinoside regimen.
Beguin Y, Bury J, Fillet G, Lennes G. Treatment of acute nonlymphocytic leukemia in young and elderly patients. Cancer 1985;56:2587-92.
Morrison FS, Kopecky KJ, Head DR, Athens JW, Balcerzak SP, Gumbart C, et al. Late intensification with POMP chemotherapy prolongs survival in acute myelogenous leukemia: results of a Southwest Oncology Group study of rubidazone versus adriamycin for remission induction, prophylactic intrathecal therapy, late intensification, and levamisole maintenance. Leukemia 1992;6:708-14.
Bennett JM, Andersen JW, Cassileth PA. Long term survival in acute myeloid leukemia: the Eastern Cooperative Oncology Group (ECOG) experience. Leuk Res 1991;15:223-7.
Keating MJ, McCredie KB, Bodey GP, Smith TL, Gehan E, Freireich EJ. Improved prospects for long-term survival in adults with acute myelogenous leukemia. JAMA 1982; 248:2481-6.
Bandini G, Zuffa E, Rosti G, Battista R, D'Emilio E, Leoni F, et al. Long-term outcome of adults with acute myelogenous leukaemia: results of a prospective, randomized study of chemotherapy with a minimal follow-up of 7 years. Br J Haematol 1991;77:486-90.
Ghaddar HM, Plunkett W, Kantarjian HM, Pierce S, Freireich EJ, Keating MJ, et al. Long-term results following treatment of newly-diagnosed acute myelogenous leukemia with continuous-infusion high-dose cytosine arabinoside. Leukemia 1994;8:1269-74.
Volger WR, Weiner RS, Moore JO, Omura GA, Bartolucci AA, Stagg M. Long-term follow-up of a randomized postinduction therapy trial in acute myelogenous leukemia: a Southeastern Cancer Study Group trial. Leukemia 1995; 9:1456-60.
Heil G, Mitrou PS, Hoelzer D, Freund M, Link H, Ehninger G, et al. 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. Ann Hematol 1995;71:219-25.
Preisler HD, Anderson K, Rai K, Cuttner J, Yates J, Du Pre E, et al. The frequency of long-term remission in patients with acute myelogenous leukaemia treated with conventional maintenance chemotherapy: a study of 760 patients with a minimal follow-up time of 6 years. Br J Haematol 1989;71:189-94.
Rowe JM, Liesveld JL. Treatment and prognostic factors in acute myeloid leukemia. Clin Haematol 1996;9:87-105.
Wiernik PH, Banks PL, Case DC Jr., Arlin ZA, Periman PO, Todd MB, et al. Cytarabine plus idarubicin or daunorubicin as induction and consolidation therapy for previously untreated adult patients with acute myeloid leukemia. Blood 1992;79:313-9.
Bishop JF, Matthews JP, Young GA, Szer J, Gillett A, Joshua D, et al. A randomized study of high-dose cytarabine in induction in acute myeloid leukemia. Blood 1996;87:1710-7.
Mayer RJ, Davis RB, Schiffer CA, Berg DT, Powell BL, Schulman P, et al. Intensive postremission chemotherapy in adults with acute myeloid leukemia. Cancer and Leukemia Group B. N Engl J Med 1994;331:896-903.
Phillips GL, Reece DE, Shepherd JD, Barnett MJ, Brown RA, Frei-Lahr DA, et al. High-dose cytarabine and daunorubicin induction and postremission chemotherapy for the treatment of acute myelogenous leukemia in adults. Blood 1991;77:1429-35.
Zittoun RA, Mandelli F, Willemze R, De Witte T, Labar B, Resegotti L, et al. Autologous or allogeneic bone marrow transplantation compared with intensive chemotherapy in acute myelogenous leukemia. N Engl J Med 1995;332:217-23.