Ten years ago, less than one fourth of patients with acute
nonlymphocyticleukemia(ANNL)-(Acute myelocytic, myelomonocytic, erythroleukemia, and
monocytic leukemia) achieved complete remission of their disease with conventional or
experimental chemotherapy.
The discovery of important activity of cytarabine and subsequently of daunomycin
was a major advance in the treatment of adults with acute leukemia.
At the present time, two thirds or more of patients with ANLL in adults will achieve
complete remission and, perhaps more importantly, the median duration of complete
remission has been substantially improved recently by a combined modality approach to
maintenance therapy. The results of these advances is that median survival of all
treated patients, and of patients who achieve complete remission in particular has greatly
improved.
In Korea, the patients with leukemia usually refuse therapy, or are lost to follow up.
Also because of inadequate supportive care such as platelet and granulocyte transfusion
many patient with acute leukemia die of infection and hemorrhage before an adequate
trial of antileukemia chemotherapy.
In 14 patients with ANLL treated with a combination of cyclophosphamide, vincristin
sulfate, prednisolon, and cytarabine (COAP) at the National Medical Center between
January 1976 and October 1978.
The following results were obtained.
1. The mean age was 39 years with a range of 17 to 68 years.
There were 8 males and 6 females.
2. Among the 14 patients who received the COAP regimen, 5 (36%) achieved complete
remission.
The complete remission rate 10 patients receiving an adequate trial of chemotherapy
was 50%.
3. The complete remission rate was 60% for patients less than 35 years old compared
to only 22% for patients more than 35 years old.
4. The mean number of courses to complete remission was 4.2 (range 3-5).
5. 10 among 14 patients could be follow up.
Three was alive and 7 was dead. The duration of survival was a range of 18 days to
25 months.
The duration of complete remission of 2 patients who was dead after achievement of
complete remission was 20 months and 11 months, and the duration of survival time 25
months and 15 months respectively.
6. Hemorrhage was a cause of death in 4 patients and infection in 3.
|