title: Risk-adapted induction and consolidation therapy in adults with de novo AML aged </= 60 years: results of a prospective multicenter trial.
abstract: We treated 305 de novo acute myeloid leukemia (AML) patients aged </=60 years with risk-adapted therapy. Patients with CBF leukemias or normal karyotype and good response to induction I [</=5% bone marrow (BM) blasts on day 15] were considered standard risk (SR), all others as high risk (HR). Patients with t(15;17) were excluded. Chemotherapy comprised double induction followed by early consolidation. As late consolidation, SR patients received high-dose cytarabine/daunorubicin (AraC/DNR). SR patients with normal karyotype were allotransplanted from HLA-matched siblings. HR patients were allotransplanted or if no sibling donor was available autotransplanted with peripheral blood progenitor cells (PBSC) harvested after early consolidation. 89% of the SR and 60% of the HR patients achieved CR. The continuous complete remission (CCR) rate at 80 months (median follow-up: 48 months) was 48% for SR and 32% for HR. The CCR rate was 54% for t(8;21), 47% for normal karyotype, and 33% for inv(16) patients. In the HR group, the CCR rate did not differ significantly for patients with bad response to IVA-I, unfavorable karyotype, or both. Forty-five HR patients were autotransplanted (n=20) or allotransplanted (n=25). The probability of CCR was 44% for autotransplantation vs 33% for allotransplantation. In conclusion, our risk-adapted strategy produced encouraging results in SR patients. Early response to therapy is a strong prognostic factor that predicts the probability of CR and long-term outcome.
authors.affiliation: Department of Hematology, Hemostaseology and Oncology, Hannover Medical School, University of Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. innere5@kkh-luedenscheid.de
authors.forename: G
authors.initials: G
authors.lastname: Heil
authors.forename: J
authors.initials: J
authors.lastname: Krauter
authors.forename: A
authors.initials: A
authors.lastname: Raghavachar
authors.forename: L
authors.initials: L
authors.lastname: Bergmann
authors.forename: D
authors.initials: D
authors.lastname: Hoelzer
authors.forename: W
authors.initials: W
authors.lastname: Fiedler
authors.forename: M
authors.initials: M
authors.lastname: Lübbert
authors.forename: L
authors.initials: L
authors.lastname: Noens
authors.forename: G
authors.initials: G
authors.lastname: Schlimok
authors.forename: R
authors.initials: R
authors.lastname: Arnold
authors.forename: H
authors.initials: H
authors.lastname: Kirchner
authors.forename: A
authors.initials: A
authors.lastname: Ganser
mesh_terms: D000293:Adolescent; D000328:Adult; D000677:Amsacrine / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003630:Daunorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage / Q000009:adverse effects; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D018570:Risk Assessment; D033581:Stem Cell Transplantation; D016019:Survival Analysis
chemical_list: D000677:Amsacrine; D003561:Cytarabine; D005047:Etoposide; D015255:Idarubicin; D003630:Daunorubicin