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Treatment of patients over 50 years of age with acute myelogenous leukemia
with a combination of rubidazone and cytosine arabinoside, vincristine, and
prednisone (ROAP)
MJ Keating, KB McCredie, RS Benjamin, GP Bodey, A Zander, TL Smith and EJ Freireich
We administered a combination of rubidazone, cytosine arabinoside,
vincristine, and prednisone (ROAP) to 91 patients with acute myelogenous
leukemia who were 50 yr of age or older. These patients had been identified
in previous studies to be a group with a relatively poor prognosis.
One-third of the patients had an antecedent hematologic disorder prior to
treatment. Forty patients (48%) obtained a complete hematologic and
clinical remission. A history of an antecedent hematologic disorder, male
sex, and absence of Auer rods were adverse factors for achieving remission
in this older population. More than half of the patients achieved remission
in one course. The major cause of failure to obtain a remission was death
due to infection, 40% of which were caused by fungi. Resistance to
chemotherapy, although uncommon, was noted more frequently in patients with
an antecedent hematologic disorder. Univariate and multivariate prognostic
factor analysis was used to compare these patients with a historical
control group treated with a program in which adriamycin was used instead
of rubidazone (AdOAP). No significant difference in remission rate was
detected. Cyclocytidine was used as a maintenance agent in this study, and
while the median remission duration was only 37 wk, 30% of patients are
expected to be in remission for 2 yr. Chemotherapy programs combining an
anthracycline with cytosine arabinoside, given to older patients in similar
fasion to younger patients will achieve remissions in one-half of a group
of older patients. These remissions are of comparable quality to those of
younger patients. Mathematical models derived from analysis of prognostic
factors are of use in identifying patients likely to fail these programs
who are in need of innovative approaches to treatment.
Volume 58,
Issue 3,
pp. 584-591,
09/01/1981
Copyright © 1981 by The American Society of Hematology
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