Delivery of intensive acute myeloed leukemia curative care in real world environments: A single center experience of 96 population based patients with potential implications to future multi-center trials

R. Powles*, S. Kulkarni, J. Treleaven, J. Mehta, S. Singhal

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Assessment of outcome in patients receiving a sequence of treatment steps at a single center is one of the best ways of judging the effectiveness of the therapy. Our total therapy program for newly diagnosed AML consists of initial chemotherapy followed by allogeneic or unpurged autologous BMT in CR1. From 4/90 to 1/00, 96 patients with de novo AML. under 55 y (15 -55 y, median 35; presentation WBC 0.2-343x 10A9 /L, median 9)BF12 induction: high-dose ARA-C and VP-16 with idarubicin (n = 88) or mitoxantrone (n = 8). Consolidation comprised of one outpatient cycle of 3 blocks of ARA-C/6-TG, and one inpatient cycle of m-amsa/ARA-C/VP-16.24 patients had favorable karyotypes [ 111(8;21 ), 71( 15;17), 6 inv( 16)], and 72 did not [25 normal, 37 other, 5 fail, 5 not done]. 79/96 (82.3%) évaluable patients attained CR ; including 22/24 with favorable karyotypes and 57/72 with other karyotypes (p=0.16). TRM was 10/96 (10%). 62(78.5%) underwent BMT in CR 1 (allo:21 ; auto:41). Of the 17 not transplanted in CR1 (9 relapse, 4 refusal, 3 death in CR,1 unfit ), 7 were transplanted in relapse and 5 with resistant disease and 4 of them are alive (2 auto and 2 allo). 2/10 patients failing to attain CR on the program survived. In total 73/96 (76%) received BMT at some stage during therapy. As of 8/00,46 patients (48%) survive 3108 months (median:28 mo) after diagnosis; 41 in continuous CR. 16of 24 patients with favorable karyotypes survive compared with 28 of 72 patients with other karyotypes (5 yr. Survival 64% vs. 38%, p=0.015). The actuarial 5-y survival from presentation is 42% (95% CI: 34-61%).5 yr probability of OS is 60% for allo and 51% for autograft in CRl(p=NS).In multi-variant analysis good cytogenetic features (RR:2.15 95% CI: 1 -4.6, p=0.049) and use of allo-BMT (RR:4.35, 95% CI:2.14-8.83, p=0.001) or auto-BMT(RR: 1.97, 95% CI:0.993.93, p=0.053)predicted for better OS. Survival was not influenced by presentation counts, age, sex and rapidity of clearing peripheral blood blasts after induction. We conclude that a sequential program integrating intensive chemotherapy and BMT is possible in adult AML. The intensive nature of the treatment isolates a group of refractory patients who cannot be salvaged by currently available treatment approaches. The results of therapy for unselected population based patients are at least as good as highly selected muti-center national studies like MRC AML 10 which recruit 5-10% of total affected population.

Original languageEnglish (US)
JournalBlood
Volume96
Issue number11 PART II
StatePublished - Dec 1 2000

ASJC Scopus subject areas

  • Hematology

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