| Popis: |
Specific chromosome aberrations are one of the most important predictive factors for response rate and remission duration in acute myeloid leukemia (AML). In June 1993, we initiated a multicenter treatment trial for adult AML (AML HD93) in which the karyotype is used for stratifying postremission therapy. The patients, except those with acute promyelocytic leukemia, receive an intensive double induction chemotherapy consisting of 2 cycles of idarubicin, standard-dose cytarabine and etoposide (ICE), followed by an early consolidation therapy with high-dose cytarabine and mitoxantrone (HAM). For second consolidation, patients ≤ 55years are stratified into three treatment arms: 1. low-risk, defined by t(8;21), inv(16), t(15;17): HAM; 2. intermediate-risk, normal karyotype: allogeneic bone marrow transplantation (BMT) for patients with an HLA-identical sibling, or S-HAM; and 3. high-risk, all other chromosome aberrations: allogeneic or autologous BMT. Patients older than 55 years are treated according the low-risk arm. At present, 172 patients (median age: 44 years; range: 16–60 years) are eligible. Central cytogenetic diagnosis which included chromosome banding analysis and molecular screening by fluorescence in situ hybridization was successful in 167 of the 172 (97%) leukemias. Complete remission (CR) rates were 98, 81 and 56% for the low-, intermediate- and high-risk group, respectively. The estimated disease-free survival (DFS) at 1.5 years is 67, 58 and 45% for the respective groups. In conclusion, the results confirm the high predictive value of the karyotype for achieving a CR. Although the median follow-up time is short, our preliminary data suggest that intensive double induction chemotherapy with ICE and postremission therapy that is stratified according to the karyotype may improve DFS for the intermediate- and high-risk leukemias. |
