Survival in 222 adult patients with acute leukaemia treated with intermittent combination chemotherapy programme

Estimated 8-year survival of more than 40% in a population-based study of 79 adult patients with acute lymphoblastic leukaemia

We report 11 years experience with a modified version of a chemotherapy programme in use at the MRC Leukaemia Unit from 1982 to 1984, supplemented by allogeneic bone marrow transplantation in first relapse or second or later remission from 1985. 79 consecutive patients aged 15-60 years with newly diagnosed acute lymphoblastic leukaemia (ALL) were given induction chemotherapy. This included a standard DAT course (daunorubicin, cytarabine and thioguanine) applied as in acute myelogenous leukaemia approximately midway in the induction programme. A 3-year rotating maintenance programme consisted of combinations of cytotoxic drugs used in the induction therapy. CNS prophylaxis did not include CNS irradiation. Allogeneic BMT was not performed in first remission. The overall complete remission (CR) rate was 82% (65/79). 26 patients relapsed (seven first in the CNS). Seven patients underwent allogeneic BMT of whom six are alive and well with a mean observation time of 32 months (range 4-99 months) after transplantation. Three patients died in first CR. Estimated 5- and 8-year overall survival was 51% (95% confidence interval (CI) 39-63) and 47% (CI 33-61). For patients who reached CR, the corresponding figures were 63% (CI 50-76) and 57% (CI 41-73). Estimated disease-free survival in the remitters was 54% (CI 40-68) at 5 years and 44% (CI 28-60) at 8 years. Patient age below 25 years and white cell count below 15 x 10(9)/l at presentation were both found to improve the chance of overall survival.

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

Ninety-one patients with acute myelogenous leukaemia (AML) aged 17-59 years were treated with a chemotherapy programme which could be completed within 30 weeks for patients who achieved complete remission (CR). Four courses included daunorubicin, cytarabine and thioguanine, while two courses included amsacrine, etoposide and cytarabine. Sixty-five patients obtained CR (71%), more often in patients below (82%) than above (60%) 40 years of age (P = 0.03). Five patients underwent allogenic bone-marrow transplantation, and one patient received an autologous bone-marrow transplant after relapse. Five patients developed central nervous system leukaemia. The overall actuarial 3- and 5-year survival was 29% and 21%, respectively; for patients who obtained CR the corresponding survival rates were 40% and 30%, respectively. Patients below 40 years of age appeared to fare better (5-year survival 26%) than older patients (5-year survival 16%). The estimated disease-free survival rate was 26% at 3 years and 22% at 5 years. The main advantage of this regimen is that results compare favourably with those obtained with other regimens were achieved, without exposing patients to long periods of maintenance therapy.

A comparison of in vitro sensitivity of acute myeloid leukemia precursors to mitoxantrone, 4'deoxydoxorubicin, 4-demethoxydaunorubicin and daunorubicin

The development of new chemotherapeutic drugs for the treatment of AML remains of continuous interest. Three new drugs currently under investigation in phase II and III clinical trials, i.e. Mitoxantrone, 4'deoxydoxorubicin and 4-demethoxydaunorubicin, were studied in vitro to directly compare their relative cytotoxicity on AML clonogenic cells from six patients. The data were compared to the sensitivity of normal bone marrow myeloid and erythroid clonogenic cells and to results obtained in similar experiments for daunorubicin. A dose dependent cytoreduction of AML and normal bone marrow progenitors was found in all cases after preincubation with the drugs. The relative cytoreductive efficacies of the different agents always correlated when tested upon the cells from the same patient. Cross resistance was demonstrated in a case of daunorubicin refractory AML. Normal bone marrow myeloid and erythroid progenitors were significantly more sensitive to the drugs than AML clonogenic cells. These in vitro data suggest that none of the new drugs is superior to daunorubicin, when the quantitative degree of cytotoxicity to AML clonogenic cells, or normal bone marrow progenitors are taken into account.