Background; With current induction chemotherapy, 60% to 80% of patients with acute myelogenous leukemia(AML) can achieve their first remission, however, the duration of remission is short and only 20% to 30% of the patients can maintain long-term
disease-free survival(DFS) after consolidation.
Clinically relevant adverse prognostic features include increasing age, cytogenetic abnormality, presence of preleukemic syndrome, FAB classification, and evidence of extramedullary disease. To identify clinical factors for a good prognosis, we
retrospectively analysed the ago, sex, FAB subgroup, percent of leukemic blasts in day 7 bone marrow after initiation of remission induction chemotherapy, and numbers of consolidation chemotherapy.
Mothods: 65 patients with AML entering complete remission from 121 patients who received intensive induction chemotherapy in St. Mary's hospital from July 1986 until December 1991 were recruited for this retrospective study. The statistical
analysis has
attempted to define clinical factors predictive of either remission duration or survival rate.
@ES Results:
@EN 1) Among 65 patients entering complete remission, the 58 patients have been followed for 3 to 57 months(median: 21 months). 4-year survival rate of patients entering complete remissoin (n=65) was 24.4%, and probability of being in remission
was
22.7%.
2) The number of postremission consolidation chemotherapy was the only significant prognostic factor influencing on long term disease free survival. No significant correlation was observed between the probability of survibval and age(40sex,
FAB subgroup, percent of leukemic blasts in day 7 bone marrow after initiation of remission induction therapy.
3) The median durations of complete remission were 10 months, 8 months and 24 months respectively for patients with 0, 1-2 and 3 or more courses of postremission consolidation chemotherapy(p=0.0098). The 4-year probability of survival
significantly
increased to 0%, 19.1% and 41.1% respectively for patients with 0, 1-2 and 3 or more courses of postremission consolidation chemotherapy(p=0.0022).
4) Treatment-related mortalities were observed in 6 patients(10.2%).
Five patients died of pneumonia, and one of cerebral hemorrhage.
Deaths due to leukemic relapse were 35 patients(89.8%).
Conclusion: Our results show that consolidation chemotherapy of at least three courses offers survival advantage and is one of effective postremission treatments in patients with AML entering complete remission.
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