title: High-dose cytosine arabinoside intensification for acute nonlymphocytic leukemia in patients over 56 years of age.
abstract: One hundred and nine consecutive patients with de novo acute nonlymphocytic leukemia aged over 56 years were admitted with the intention of administering high-dose cytosine arabinoside (HD Ara-C) intensification. After remission induction, the patients were consolidated with a course of daunorubicin (30 mg/m2/day, days 1-3) and Ara-C (100 mg/m2/day, days 1-7), followed by the intensification (Ara-C, 2 g/m2/12 h, days 1-4). The planned induction course was not started in 13 patients because of cardiac failure or unsatisfactory general status. Remission was achieved in 55% (53/96) of the patients. Twenty-seven patients (28%) had refractory disease, seven died early during induction therapy, five died of hemorrhage and three of infection during the hypoplasia that followed induction treatment. Thirty-nine patients started consolidation and 32 had the planned intensification. In these last patients the 3-year leukemia-free survival (LFS) probability was 29% (SE, 8%). No patient died as a consequence of intensification. The relapse rate of the intensified patients did not differ from the relapse rate of those patients who did not receive the planned intensification (p = 0.12). The only pretreatment variables significantly associated with a better LFS were younger age (p = 0.02) and a low WBC at diagnosis (p = 0.04). For the whole patient group, the 3-year survival probability was 15% (SE, 4%). This study shows that elderly patients can tolerate HD Ara-C. The patients completing consolidation-intensification have a currently acceptable LFS. To what extent HD Ara-C contributed to the length of the remissions remains unclear.
authors.affiliation: Department of Hematology, University of Louvain, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Ferrant
authors.forename: C
authors.initials: C
authors.lastname: Doyen
authors.forename: A
authors.initials: A
authors.lastname: Delannoy
authors.forename: L
authors.initials: L
authors.lastname: Van den Bossche
authors.forename: P
authors.initials: P
authors.lastname: Martiat
authors.forename: V
authors.initials: V
authors.lastname: Deneys
authors.forename: M
authors.initials: M
authors.lastname: De Bruyère
authors.forename: A
authors.initials: A
authors.lastname: Bosly
authors.forename: J L
authors.initials: JL
authors.lastname: Michaux
authors.forename: G
authors.initials: G
authors.lastname: Sokal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003561:Cytarabine / Q000008:administration & dosage* / Q000633:toxicity; D004305:Dose-Response Relationship, Drug; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D013921:Thrombocytopenia / Q000139:chemically induced
chemical_list: D003561:Cytarabine