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Effect of aggressive daunomycin therapy on survival in acute promyelocytic
leukemia
D Head, KJ Kopecky, J Weick, JC Files, D Ryan, K Foucar, M Montiel, J Bickers, A Fishleder and M Miller
St Jude Children's Research Hospital, Memphis, TN, USA.
The Southwest Oncology Group analyzed outcome with cytotoxic chemotherapy
for previously untreated acute myeloblastic leukemia (AML) from 1982
through 1986. Results with acute promyelocytic leukemia (APL) prompted
comparison with patients from 1986 through 1991 and analysis of factors
contributing to APL results. Patient and disease characteristics and
treatment outcome were compared for all evaluable patients, with more
detailed analysis of factors affecting APL treatment outcome. From 1982
through 1986, median survival and disease- free survival in 45 APL patients
were 106 months and greater than 105 months, respectively, versus 6 and 14
months for 417 other AML patients. Such differences were not seen from 1986
through 1991. In the 141 APL patients from 1982 through 1991, after
adjusting for significant patient and disease characteristics, higher
daunomycin (DNR) doses during induction were significantly associated with
higher complete remission rates (P < .0001), longer survival (P <
.0001), and longer DFS (P < .0001). Cytosine arabinoside (Ara-C)
induction dose, the inclusion of other chemotherapy agents in induction,
postremission therapy (consolidation, maintenance, or bone marrow
transplantation) other than DNR, APL subtype, and patient age did not
appear to significantly affect outcome of APL, except for a significant
detrimental effect of high-dose Ara-C in consolidation (P = .0042).
Morphologic AML subtypes other than APL did not affect outcome. We conclude
that high-dose DNR selectively increases survival in APL. This good
survival is important for evaluation of combined all-trans retinoic acid
(ATRA)/chemotherapy protocols and for planning future combinations of
chemotherapy and ATRA. These results illustrate the need to individualize
chemotherapy for subtypes of AML. Therapeutic response of APL is
independent of age. Except for APL, morphologic subclassification of AML
contributed little prognostic information.
Volume 86,
Issue 5,
pp. 1717-1728,
09/01/1995
Copyright © 1995 by The American Society of Hematology
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