Efficacy of intensive chemotherapy for acute myelogenous leukemia associated with a preleukemic syndrome.
One hundred ninety-six patients with acute myelogenous leukemia (AML) were treated with intensive induction chemotherapy using similar daunorubicin/cytarabine/thioguanine regimens. Treatment results of 44 patients who had a documented preleukemic syndrome or cytopenia present for more than 2 months before developing over AML were compared with 152 patients with de novo AML. Eighteen (41%) patients with preleukemia evolving into AML achieved complete remission compared with 111 (73%) patients with de novo AML (P less than .01). Patients with preleukemia-AML had a significantly longer period to recovery of granulocytes. Multivariate analysis indicated that presence of a previous preleukemic syndrome and advancing age were independent poor prognostic indicators for achieving remission. For patients who achieved remission, disease-free survival and overall survival were also inferior for patients with previous preleukemia; disease-free survival was 17 +/- 17% at 3 years compared with 29 +/- 10% in patients with de novo AML (P = .02). These data indicate that intensive chemotherapy has limited efficacy in patients with AML following a preleukemic syndrome. Durable remissions may be achieved in some patients.
Gajewski
J L
JL
Division of Hematology/Oncology University of California, Los Angeles 90024.
Ho
W G
WG
Nimer
S D
SD
Hirji
K F
KF
Gekelman
L
L
Jacobs
A D
AD
Champlin
R E
RE
D000367:Age Factors; D000741:Anemia, Aplastic / Q000150:complications; D000754:Anemia, Refractory, with Excess of Blasts / Q000150:complications; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy*; D015999:Multivariate Analysis; D009436:Neural Tube Defects / Q000150:complications; D011289:Preleukemia / Q000150:complications*; D011379:Prognosis; D012044:Regression Analysis; D015996:Survival Rate; D013866:Thioguanine / Q000008:administration & dosage
D003561:Cytarabine; D013866:Thioguanine; D003630:Daunorubicin