Survival in acute myeloblastic leukemia is not prolonged by remission maintenance or early reinduction chemotherapy. The Toronto Leukemia Study Group.
A role for post-induction chemotherapy for adult patients with acute myeloblastic leukemia in remission has not been established. We have studied 125 patients with acute myeloblastic leukemia in complete remission to determine the effect on survival of remission maintenance therapy and of early reinduction therapy given at the time of predicted imminent relapse. Following remission induction with 6-thioguanine, cytosine arabinoside and daunorubicin (TAD), all patients received consolidation therapy with these same three drugs. Forty-three patients were randomized to arm A, continuing chemotherapy; 40 patients were randomized to arm B, no further chemotherapy until morphological relapse; and 42 patients were randomized to arm C, no further chemotherapy until an increase in myeloblast associated antigens was detected in bone marrow by means of antimyeloblast heteroantisera. The median durations of complete remission, age adjusted, for the three groups are not significantly different: 15.7 months for group A, 16.2 months for group B and 14.1 months for group C. The age adjusted median survivals for the three groups are also not significantly different: 17.6 months for group A, 21.8 months for group B and 18.8 months for group C. Quality of life was determined to be superior for patients having no further maintenance therapy (arms B and C). We conclude that our patients receiving induction and consolidation therapy with TAD did not benefit from remission maintenance or early reinduction chemotherapy, and had an improved quality of life if no maintenance therapy was given.
D000293:Adolescent; D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000401:mortality*; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D011897:Random Allocation; D012074:Remission Induction; D013997:Time Factors