Survival in 91 adults with acute myelogenous leukaemia treated with 1-6 intensive courses of chemotherapy

Survival in 86 patients, aged 15-60, with primary acute myelogenous leukemia, treated with a common program in the Norwegian health regions I, III, IV and V in the period 1990-1995

Eighty-six patients between 15 and 60 yr with primary acute myelogenous leukemia in health regions I, III, IV and V in Norway were treated according to a common protocol from 21 January 1990 until 1 September 1995 (until 1 January 1993 for health region IV). Seventy-one percent of the patients reached complete remission (CR) and went on to receive consolidation treatment. In addition to chemotherapy, 18 patients under the age of 52, i.e. 28% of all patients in this age group, received allogeneic bone marrow transplantation. A follow-up analysis was performed by 1 September 1996. The median overall survival was 15 months, estimated 3-yr survival 30% and estimated survival at 5 yr was 26%. The median duration of 1st CR was 19 months, and the leukemia-free survival at 3 yr was 29%. At follow-up 26/86 patients were alive, 18 in 1st CR (4 after BMT) and 8 in 2nd CR (5 after BMT in 2nd, 1 after BMT in early 1st relapse). These results are comparable to many previously published studies, but may be inferior to the results obtained with more intensive consolidation treatment, including high dose Ara C.

Adult acute leukaemia--a retrospective study of 66 consecutive patients

BACKGROUND

Advances in therapy and supportive care have improved the outlook for many patients with acute leukaemia, however elderly patients have increased treatment-related toxicity and shorter survival. Most clinical trials have selected patient populations with young median ages and it is therefore difficult to apply results to the general population where the majority of patients presenting with acute leukaemia are over 60 years. There is little information in the literature guiding appropriate treatment of these patients.

AIMS

To determine the relationship between age, treatment received, and outcome in patients presenting with acute leukaemia.

METHODS

A retrospective analysis was performed on all patients presenting to Prince Henry's Hospital and Monash Medical Centre with acute myeloid leukaemia (AML) or acute lymphocytic leukaemia (ALL) during a five year period.

RESULTS

Sixty-six patients (51-AML, 15-ALL) presented with acute leukaemia between March 1989 and April 1994. Median patient age was 63 years; 32% of patients received supportive therapy only; 86% of patients with ALL and 58% of patients with AML commencing remission-induction chemotherapy entered a complete remission. Median survival for patients receiving only supportive therapy was three months. Median survival in patients under 55 years was almost twice as long as patients over 55 years receiving similar treatment (AML-eight vs four months p = 0.023; ALL-3.5 vs seven months p = 0.029).

CONCLUSIONS

Median survival for acute leukaemia is inversely proportional to age. Applying results from selected series to elderly patients with acute leukaemia is inappropriate.

Outcome of a multicenter treatment program including autologous or allogeneic bone marrow transplantation for de novo acute myeloid leukemia

The results of an intensive treatment program for patients 16-60 yr of age with de novo acute myeloid leukemia are presented. The patients were given conventional induction treatment with daunorubicin and cytarabine. Patients not entering complete remission (CR) after 1 course of daunorubicin/cytarabine were given 1 course of amsacrine/etoposide/cytarabine. Those entering complete remission received 3 consolidation courses using mitoxantrone, etoposide, amsacrine and cytarabine. One hundred and eighteen patients were enrolled. Complete remission was attained after 1-2 courses in 90 patients (76%). Another 6 patients reached CR after 3-4 induction courses for a total CR rate of 81%. If feasible, patients were offered either allogeneic or unpurged autologous bone marrow transplantation. Twenty-four patients underwent allogeneic bone marrow transplantation; 15 in first remission, 8 in second remission, 1 in early relapse. Thirty patients below 56 yr of age underwent autologous bone marrow transplantation in first remission. The overall probability of survival at 4 yr was 34%, and for patients below 40 yr of age 50%. Leukemia-free survival was 35% for the whole cohort of patients; 52% for patients below 40 yr of age. Patients undergoing allogeneic or autologous bone marrow transplantation in first remission had an overall survival of 86% and 47%, respectively, while the probability of leukemia-free survival in these groups was 87% vs. 40% at 4 yr. The CR rate and long-term results of this intensive treatment program compare favorably with other recent studies using intensive consolidation with allogeneic or autologous bone marrow transplantation or high dose cytarabine.

Acute leukemia in middle Norway 1984-88

One hundred and eight adult patients with acute leukemia were diagnosed in the middle Norwegian health region during the 5-year period 1984-88, giving an incidence rate of 4.6/100,000 per year. Nine patients had acute lymphoblastic leukemia (ALL), 93 acute myeloid leukemia (AML) and 6 patients acute leukemia without definite sub-classification. The median age of AML patients was 66 years. Thirty-five patients (median age 78 years) were found non-suitable for cytotoxic drugs, while 58 AML patients (median age 57 years) were given aplasia-inducing drug combinations according to one of three treatment programs depending on the time of diagnosis and age, in order to induce remission. Six patients were given oral drugs or low dose ara-C. All patients were followed until death or for an observation time of more than 5 years (median 7 years). The overall long term survival was found to be 12/108 for all acute leukemias, 8/93 for AML patients and 4/9 for ALL patients. For the AML patients given intravenous aplasia-inducing drugs the remission rate was 0.65, the median remission duration 12.2 months and the 5-year survival rate 0.19. For 31 AML patients, (median age 41 years), started on an intensive chemotherapy program, the 5-year survival rate was 0.32 and the relapse-free 5-year survival rate for the 22 patients entering complete remission was also 0.32.