Risk-adapted induction and consolidation therapy in adults with de novo AML aged ≤ 60 years: results of a prospective multicenter trial


We treated 305 de novo acute myeloid leukemia (AML) patients aged ≤60 years with risk-adapted therapy. Patients with CBF leukemias or normal karyotype and good response to induction I [≤5% bone marrow (BM) blasts on day 15] were considered standard risk (SR), all others as high risk (HR). Patients with t(15;17) were excluded. Chemotherapy comprised double induction followed by early consolidation. As late consolidation, SR patients received high-dose cytarabine/daunorubicin (AraC/DNR). SR patients with normal karyotype were allotransplanted from HLA-matched siblings. HR patients were allotransplanted or if no sibling donor was available autotransplanted with peripheral blood progenitor cells (PBSC) harvested after early consolidation. 89% of the SR and 60% of the HR patients achieved CR. The continuous complete remission (CCR) rate at 80 months (median follow-up: 48 months) was 48% for SR and 32% for HR. The CCR rate was 54% for t(8;21), 47% for normal karyotype, and 33% for inv(16) patients. In the HR group, the CCR rate did not differ significantly for patients with bad response to IVA-I, unfavorable karyotype, or both. Forty-five HR patients were autotransplanted (n=20) or allotransplanted (n=25). The probability of CCR was 44% for autotransplantation vs 33% for allotransplantation. In conclusion, our risk-adapted strategy produced encouraging results in SR patients. Early response to therapy is a strong prognostic factor that predicts the probability of CR and long-term outcome.

DOI: 10.1007/s00277-004-0853-z

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@article{Heil2004RiskadaptedIA, title={Risk-adapted induction and consolidation therapy in adults with de novo AML aged ≤ 60 years: results of a prospective multicenter trial}, author={Gerhard Heil and J{\"{u}rgen G E Krauter and Ar. Raghavachar and Lothar Bergmann and Dieter Hoelzer and Walter Fiedler and Michael Luebbert and Lucien A. Noens and G{\"{u}nter Schlimok and Raoul Arnold and Hartmut H Kirchner and Arnold Ganser}, journal={Annals of Hematology}, year={2004}, volume={83}, pages={336-344} }