[Therapy of malignant systemic diseases: hemoblastoses and malignant lymphomas]

Abstract

Recent progress in the treatment of acute leukemias in adults includes combination chemotherapy (TAD) and the use of high-dose antimetabolites (methotrexate plus citrovorum rescue or high-dose cytosine-arabinoside). The role of post-induction chemotherapy is still controversial especially with regard to the maintenance chemotherapy. The German AML (acute myeloid leukemia) Cooperative Group started a cooperative multi-center comparative trial to evaluate the validity of maintenance chemotherapy in patients with AML. A complete remission rate of 61% was achieved. The median time to complete remission was 33 days, and a complete remission was obtained in 68% of responders after only 1 course of therapy. Patients in complete remission were eligible for randomization for TAD consolidation with or without monthly maintenance chemotherapy. The up-dated life-table analysis revealed a predicted rate of continuous complete remission at 2 1/2 years of 30% for the maintenance and 17% for the non-maintenance group of patients (p = 0.003). On the basis of these results post-induction myelosuppressive chemotherapy appears to be substantial for achieving long-term remissions in AML. In addition, consolidation chemotherapy together with monthly maintenance seems to be superior to consolidation in prolonging the remission duration. In adult ALL/AUL (acute lymphatic/undifferentiated leukemia) complete remission rates amount to 60-85% and remission durations of 9-25 months have been reported.(ABSTRACT TRUNCATED AT 250 WORDS)