Current Clinical Practice: Acute Myeloblastic Leukemia: Management with High-Dose Cytosine Arabinoside, Daunorubicin and Marrow Transplantation

Abstract

Combination high-dose cytosine arabinoside (ARA-C) and daunorubicin (DNR) for primary remission induction of patients with acute myeloblastic leukemia (AML) was evaluated in a single institution study. Patients aged 55 or less with an HLA-sibling received an allogeneic bone marrow transplant (alloBMT) in first remission; other responders were offered autologous BMT (autoBMT). For remission induction 93 patients aged less than 60 received DNR 45mg/m² BSA×3 and ARA-C 2 gm/m² BSA every 12 hours for 12 doses; 53 aged 60 or older DNR 25mg/m²daily×3 and ARA-C 1.5–2.0gm/m² BSA every 12 hours for 12 doses. Consolidation doses of DNR were the same but ARA-C 100mg/m² BSA/day×5 was given by continuous intravenous infusion. The complete remission rate for patients less than 60 years was 69.9% (95% CI: 59.5–79.0%) and 47.2% (95% CI: 33.3–61.4%) for the older patients. The median duration of first remission for the younger patients was 13.0 months and of overall survival 17.9 months; for patients over 60 years 5.6 and 10.0 months respectively. Disease-free survival and overall survival of the 19 patients receiving alloBMT and the 13 patients undergoing autoBMT aged less than 55 years and in first or second complete remission were significantly increased compared with 22 patients in remission but not having BMT (p < 0.001 and p < 0.013). The results support the effectiveness of high-dose ARA-C for remission induction, a need for intensive consolidation therapy and a role for BMT in the management of AML.

Keywords:

• AML
• cytosine arabinoside
• daunorubicin
• clinical trials
• bone marrow transplant