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Long‐term survival of patients with acute myeloid leukemia
Author(s) -
Bloomfield Clara D.,
Herzig Geoffrey P.,
Peterson Bruce A.,
Wolff Steven N.
Publication year - 1997
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19971201)80:11+<2186::aid-cncr4>3.0.co;2-g
Subject(s) - medicine , cytarabine , myeloid leukemia , chemotherapy , survival rate , surgery , leukemia
BACKGROUND Although the prospect of long‐term disease free survival (LFS) after chemotherapy for acute myeloid leukemia (AML) is widely accepted, few studies have reported long‐term survival data. The authors therefore updated results from a 1981 report on a study conducted by the University of Minnesota Masonic Cancer Center (UMMCC) and a 1989 report on a study conducted by the North American Marrow Transplant Group (NAMTG). METHODS Minimum follow‐up of 21.6 years for living patients was obtained for 26 patients who received weekly cytarabine and 6‐thioguanine maintenance therapy after achieving complete remission (CR) in the UMMCC study. Minimum follow‐up of 7.7 years was obtained on 87 patients treated with high dose cytarabine intensification in first remission in the NAMTG study. RESULTS In the UMMCC study, the LFS rate was 28% and the overall survival rate was 15%. Nineteen percent of patients died in first CR at 1.3‐12 years. Three patients remain alive in initial CR at >20 years. In the NAMTG study, the LFS rate was 49% and the overall survival rate was 45%. A total of 38 patients (44%) remain alive in initial CR at a median of 11.4 years after diagnosis. An additional patient is alive in second CR at 8.6 years after diagnosis. In both studies, relapses after 3 years were relatively uncommon (11‐12%). CONCLUSIONS Chemotherapy alone is curative in more than 40% of AML patients who achieve CR. Short‐term, high dose cytarabine intensification appeared more efficacious, without increased toxicity, compared with low dose, prolonged cytarabine‐based maintenance. However, for patients who cannot receive intensification, prolonged, low dose maintenance therapy is an acceptable alternative for achieving cure. A minimum follow‐up of 3 years is a reasonable predictor of long‐term survival and should be obtained in studies evaluating therapeutic outcome in cases of AML. Cancer 1997; 80:2186‐90. © 1997 American Cancer Society.