Patients with acute myeloid leukemia are traditionally treated with induction chemotherapy utilizing an anthracycline and cytarabine. Patients who achieve a complete response receive consolidation with 1 or more courses of chemotherapy or high-dose chemotherapy and stem cell transplantation. Frequently only one consolidation course is given which compromises the intensity of consolidation treatment resulting in lower cure rates.
As a generality, patients with a translocation of chromosome 8 to chromosome 21 have a better outcome than other patients with acute myeloid leukemia. For the “good risk” patients with potentially curable leukemia i.e. those with the 8; 21 translocation, a reduction in the amount of consolidation therapy can unnecessarily reduce the chance for cure.
Physicians affiliated with the Leukemia Group B have recently reported the results of several clinical trials in which patients received one or three cycles of high-dose cytarabine consolidation after achieving complete remission. Fifty patients with acute myeloid leukemia and the 8;21 translocation under the age of 61 were evaluated and compared based on whether they received one or 3 or more cycles of consolidation therapy.
Sixty-two per cent of patients receiving one cycle of consolidation therapy experienced recurrent leukemia compared to 19% of patients receiving 3 cycles or more. Of patients assigned to one cycle of consolidation therapy, only 41% survived compared to 75% of patients receiving 3 or more cycles of consolidation therapy.
This clinical study clearly demonstrates that the intensity of consolidation treatment affects survival in younger patients with good risk acute myeloid leukemia as defined by the 8;21 translocation. However, whether or not older patients benefit from more intensive treatment is less clear because side effects may outweigh the benefits of aggressive treatment.
The other unknown is whether or not patients would derive similar benefit from one cycle of high-dose chemotherapy supported by autologous peripheral blood stem cells. For patients who are unlikely to agree to or poorly tolerate multiple cycles of intensive consolidation chemotherapy, an autologous or allogeneic bone marrow or blood stem cell transplantation should be considered. (Journal of Clinical Oncology, Vol 17, No 12, pp 3767-3775, 1999)
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