Clinical value of long-term maintenance chemotherapy in 5-year survivors of acute leukemia.
We investigated whether long-term follow-up of 5-year or longer survivors of acute leukemia might provide some information concerning cure-oriented chemotherapeutic strategy. By sending a questionnaire form to major medical institutions throughout the country, data of 2202 5-year or longer survivors of acute leukemia was obtained as of 30 June 1988. There were 1607 children and 595 adults. In order to investigate the data further, they were divided into four periods according to the year of diagnosis: before 1969, 1970-1974, 1975-1979 and 1980-April 1983. As regards remission induction regimens, vincristine plus prednisolone (VP) was the most popular in childhood acute lymphoblastic leukemia (ALL) throughout these four periods. In adult acute non-lymphoblastic leukemia (ANLL), daunomycin (DM), cytosine arabinoside (ard-C), 6-mercaptopurine (6MP), prednisolone (STH) (DCMP) or behenoyl ara-C, DM, 6-MP, STH (BH-AC.DMP) was the most popular since the latter half of the 1970s. Both in childhood ANLL and adult ALL, there was no predominant regimen whatsoever. In an analysis of survival curves for the above four periods, each survival plateau for childhood ALL rose over time with statistical significance, reaching over 90% in the 1980s, whereas those for adult ANLL were not so, suggesting that newer ANLL regimens in the 1980s did not play a successful role in cure-oriented therapy. Whether duration of post-remission chemotherapy could be a prognostic factor for these survivors was studied by dividing the duration as follows: less than one year, 1-2, 2-3, 3-5 and more than 5 years. A therapeutic gain, with a cure rate of over 90%, was observed in childhood ALL patients treated with chemotherapy for 5 years or longer. In adult ANLL patients, results were similar with chemotherapy groups of both less than one year and 5 years or longer. This suggests that risk-adapted therapy is an optimal strategy for cure of adult ANLL as well as childhood ALL.
Kawashima
K
K
First Department of Internal Medicine, Nagoya University School of Medicine, Japan.
Hamajima
N
N
Yamada
K
K
Saito
H
H
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D006801:Humans; D007938:Leukemia / Q000188:drug therapy*; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016019:Survival Analysis
D000970:Antineoplastic Agents