Progress in management of acute myeloid leukaemia (AML) in Australia since 1980: a single institution retrospective study.
BACKGROUND
Much research has been conducted into the pathobiology, diagnosis, and management of acute myeloid leukaemia (AML) since 1980, with major contributions from Australian studies in this period.


OBJECTIVE
To determine whether advances in basic and clinical research into AML have translated into improved survival for patients in the community.


METHODS
A retrospective survey of records of all patients with AML presenting to the Royal Melbourne Hospital (RMH) over a 16 year period, analysed according to induction therapy and established prognostic factors. Between 1980 and December 1996 223 (98%) of 227 patients were evaluable.


RESULTS
The probability of survival at five years for patients treated since 1990 has improved significantly compared to the cohort treated between 1980-89 (34 +/- 5% vs 4 +/- 2%; mean +/- standard error). This benefit is most evident in patients less than 60 years of age (50 +/- 7% vs 11 +/- 4%). Successive induction protocols in the context of clinical trials conducted since 1985 contributed to improved outcomes. The selective application of bone marrow transplantation, and use of retinoic acid as induction therapy for acute promyelocytic leukaemia has also improved survival. Despite increases in dose-intensity, early death rates for patients undergoing induction therapy fell during the study period.


CONCLUSIONS
Participation in clinical and basic research with the development of more intense and specific treatments for patients with AML has contributed to better outcomes, underpinned by improvements in supportive care.
Thomas
D M
DM
Royal Melbourne Hospital, Department of Haematology and Medical Oncology, Parkville, Vic.
Seymour
J F
JF
Szer
J
J
Grigg
A P
AP
Basser
R L
RL
Green
M D
MD
Fox
R M
RM
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D016026:Bone Marrow Transplantation; D005260:Female; D006801:Humans; D007951:Leukemia, Myeloid / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis