Outcome of induction and postremission therapy in younger adults with acute myeloid leukemia with normal karyotype: a cancer and leukemia group B study.
OBJECTIVE
Evaluate the outcome of induction and postremission therapy in adults younger than 60 years with normal cytogenetics acute myeloid leukemia (AML).


METHODS
In 490 patients, induction included cytarabine and daunorubicin (AD) or cytarabine and escalated doses of daunorubicin and etoposide +/- PSC-833 (ADE/ADEP). Intensification included one cycle of high-dose cytarabine (HDAC) followed by etoposide/cyclophosphamide and mitoxantrone/diaziquone (group I), three HDAC cycles (group II), four intermediate-dose cytarabine (IDAC) or HDAC cycles (group III), or one HDAC/etoposide cycle and autologous stem-cell transplantation (ASCT; group IV).


RESULTS
Of 350 patients receiving AD, 73% achieved complete remission (CR), compared with 82% of 140 receiving ADE/ADEP (P = .04). Splenomegaly was associated with a lower CR rate (P < .001), and ADE/ADEP, with a higher CR rate in younger patients (P = .005). The 5-year disease-free survival (DFS) rate was 28% each for intensification groups I and II, compared with 41% and 45% for groups III and IV, respectively (P = .02). The 5-year cumulative incidence of relapse (CIR) was 62% and 67% for groups I and II, respectively, compared with 54% and 44% for groups III and IV, respectively (P = .049). The type of postremission intensification remained significant for DFS and CIR in multivariable analysis.


CONCLUSIONS
In younger adults with normal cytogenetics AML, splenomegaly predicts a lower CR rate, and the postremission strategies of either four cycles of I/HDAC or one cycle of HDAC/etoposide followed by ASCT are associated with improved DFS and reduced relapse compared with therapies that include fewer cycles of cytarabine or no transplantation.
Farag
Sherif S
SS
Division of Hematology and Oncology, Department of Internal Medicine, The Ohio State University, A433A Starling-Loving Hall, 320 W Tenth Avenue, Columbus, OH 43210, USA. farag-1@medctr.osu.edu
Ruppert
Amy S
AS
Mrózek
Krzysztof
K
Mayer
Robert J
RJ
Stone
Richard M
RM
Carroll
Andrew J
AJ
Powell
Bayard L
BL
Moore
Joseph O
JO
Pettenati
Mark J
MJ
Koduru
Prasad R K
PR
Stamberg
Judith
J
Baer
Maria R
MR
Block
Annemarie W
AW
Vardiman
James W
JW
Kolitz
Jonathan E
JE
Schiffer
Charles A
CA
Larson
Richard A
RA
Bloomfield
Clara D
CD
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001388:Aziridines / Q000008:administration & dosage; D016227:Benzoquinones / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007621:Karyotyping; D007951:Leukemia, Myeloid / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D011379:Prognosis; D012008:Recurrence; D013163:Splenomegaly; D016019:Survival Analysis; D016896:Treatment Outcome
D001388:Aziridines; D016227:Benzoquinones; D003561:Cytarabine; D005047:Etoposide; D003520:Cyclophosphamide; D008942:Mitoxantrone; C029108:diaziquone; D003630:Daunorubicin