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Acute monocytic leukaemia in adults: treatment and prognosis in 99 cases
Author(s) -
Fenaux Pierre,
Vanhaesbroucke Colette,
Estienne Marie Hélégne,
Preud'homme Claude,
Pagniez Dominique,
Facon Thierry,
Millot Frédéric,
Bauters Francis
Publication year - 1990
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1990.tb02614.x
Subject(s) - medicine , acute monocytic leukemia , chemotherapy , anthracycline , regimen , surgery , disease , disseminated intravascular coagulation , cytarabine , gastroenterology , leukemia , cancer , breast cancer
Summary Acute monocytic leukaemia (AMoL) was diagnosed in 99 adults, aged 18–85 years (median 56) over a period of 10 years. Sixty‐five patients had extramedullary leukaemia, 13 had clinical signs of leucostasis, and 19 had disseminated intravascular coagulation. Four patients died before receiving any treatment, 12 received supportive care only and seven received low dose AraC, but only one of them responded. Seventy‐six patients received intensive chemotherapy, 72 of them with an anthracycline‐AraC based regimen, with or without an epipodophyllotoxin. Fifteen patients died within 7 d of diagnosis, due to leucostasis in nine cases. Predictive factors for early death were advanced age, leucostasis, fever, leucocytes above 100 x 10 9 /l, and renal failure. Fifty (66%) of the patients treated intensively reached complete remission (CR). Advanced age, fever and complex cytogenetic abnormalities were significantly associated with a lower CR rate. Median actuarial disease‐free survival was 20.5 months, and was not significantly influenced by any pretreatment parameter. Five patients relapsed in the central nervous system (CNS), in spite of systematic CNS prophylaxis. No differences in CR rates were seen with the three anthracycline–AraC based regimens used in our patients. Significant differences in disease‐free survival were seen between them, however, suggesting that early consolidation chemotherapy and, more hypothetically, epipodophyllotoxin agents could prolong remission duration in AMoL.