Post-remission therapy of adult acute myeloid leukemia: high dose cytosine-arabinoside versus other consolidation regimens

Abstract

Introduction: Modern therapy makes it possible for 60-80% patients with acute myeloid leukemia to achieve complete remission after induction therapy. However, most of them will relapse within six months to a year without additional cytostatic therapy. The questions regarding post-remission therapy remain unanswered. The objective of this study was to compare the survival and relapse rate among the patients who had received high dose cytosine-arabinoside during consolidation therapy and the patients who had not received high dose cytosine-arabinoside during consolidation therapy.

Material and methods: The study included 59 patients aged 18-60 years with de novo acute myeloid leukemia (except for Acute promyelocytic leukemia, which was excluded according to the French-American-British classification) who achieved complete remission. Thirty-nine patients who received high dose cytosine-arabinoside during consolidation were included in the study group and twenty patients who did not receive high dose cytosine-arabinoside during consolidation were in the control group.

Results: The results show a statistically significantly longer survival rate (p = 0.003) and a lower relapse rate (p = 0.02) among the study group patients, who received high dose cytosine-arabinoside during consolidation, compared to the controls, who did not receive high dose cytosine-arabinoside. The univariate analysis in the study group suggests that the affiliation to Acute myeloblastic leukemia with maturation and Acute myelomonocytic leukemia subgroups, as well as achieving complete remission after a single induction therapy has the prognostic significance. In the multivariate analysis, only the affiliation to Acute myeloblastic leukemia with maturation and Acute myelomonocytic leukemia subgroups retained the independent prognostic significance.

Conclusion: This study has demonstrated that high dose cytosine-arabinoside used for consolidation therapy results in the higher survival rate and lower relapse rate compared to consolidation therapy without high dose cytosine-arabinoside. Only the patients within Acute myeloblastic leukemia with maturation and Acute myelomonocytic leukemia subgroups benefited significantly from high dose cytosine-arabinoside.