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Timed-sequential induction therapy improves postremission outcome in acute
myeloid leukemia: a report from the Children's Cancer Group
WG Woods, N Kobrinsky, JD Buckley, JW Lee, J Sanders, S Neudorf, S Gold, DR Barnard, J DeSwarte, K Dusenbery, D Kalousek, DC Arthur and BJ Lange
University of Minnesota, Minneapolis, MN, USA.
Timed sequencing of cycles of induction chemotherapy in acute myeloid
leukemia (AML) has been proposed as a way to achieve maximal leukemic cell
kill through recruitment and synchronization of residual neoplastic cells.
Furthermore, whether intensive induction therapy should be continued in the
presence of profound myelosuppression is an important question. The
Children's Cancer Group (CCG) conducted a prospective randomized trial in
which 589 patients with AML were randomized at diagnosis to one of two
induction approaches involving a 4-day cycle of five active
chemotherapeutic agents, with the second cycle administered either 10 days
after the first cycle, despite low or dropping blood counts (intensive
timing), or 14 days or later from the beginning of the first cycle,
depending on bone marrow status (standard timing). All patients achieving
remission received a total of four cycles of induction therapy. They were
then allocated to allogeneic bone marrow transplantation (BMT) if a
compatible family donor was present or randomized to aggressive
nonmyeloablative therapy or to myeloablative therapy with purged autologous
BMT rescue. The three postremission arms remain coded. Induction success
and median days to complete induction were similar for the 295 patients
randomized to the intensive timing arm (75%, 99 days) compared with the 294
patients randomized to the standard timing arm (70%, 105 days; P = .18 for
remission). However, a marked improvement in outcome was demonstrated in
patients randomized to the intensive timing arm, with an actuarial
event-free survival at 3 years of 42% +/- 7% (95% confidence interval [CI])
versus 27% +/- 6% for patients on the standard timing arm (P = .0005).
Disease-free survival results at 3 years from the end of induction were
superior for patients receiving intensively timed induction therapy (N =
211), 55% +/- 9% versus 37% +/- 9% for standard timing patients (N = 195, P
= .0002), with a median follow-up from achieving remission of 28 months.
Superior results were documented for patients receiving intensive timing
irrespective of the postremission therapy to which they were allocated.
Intensively timed induction therapy for patients with AML markedly improves
event-free survival, even for patients undergoing myeloablative therapy
with BMT rescue. Without controlling for the type of induction therapy
received, results of various BMT studies in AML comparing different
preparative regimens will be difficult to interpret.
Volume 87,
Issue 12,
pp. 4979-4989,
06/15/1996
Copyright © 1996 by The American Society of Hematology

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J.-L. Harousseau, J.-Y. Cahn, B. Pignon, F. Witz, N. Milpied, M. Delain, B. Lioure, T. Lamy, B. Desablens, F. Guilhot, et al.
Comparison of Autologous Bone Marrow Transplantation and Intensive Chemotherapy as Postremission Therapy in Adult Acute Myeloid Leukemia
Blood,
October 15, 1997;
90(8):
2978 - 2986.
[Abstract]
[Full Text]
[PDF]
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