Attempts to Optimize Induction and Consolidation Treatment in Acute Myeloid Leukemia: Results of the MRC AML12 Trial
Attempts to Optimize Induction and Consolidation Treatment in Acute Myeloid Leukemia: Results of the MRC AML12 Trial
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DOI：
10.1200/jco.2009.22.9088
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发表时间：
2010-02-01
影响因子：
45.3
通讯作者：
Wheatley, Keith
中科院分区：
文献类型：
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作者：
Burnett, Alan K.;Hills, Robert K.;Wheatley, Keith
PurposeTo通过比较诱导方案和巩固疗程的数量以及巩固是否应包括transplantation.Patients和MethodsWe随机分配1，658例年龄小于60岁的患者接受米托蒽醌/阿糖胞苷/依托泊苷与阿糖胞苷/柔红霉素/依托泊苷，193例患者接受柔红霉素/阿糖胞苷/硫鸟嘌呤（DAT）治疗，其中阿糖胞苷剂量为标准剂量（S-DAT）与标准剂量的两倍（H-DAT）。随机分组的患者被随机分配至全反式维甲酸组或非全反式维甲酸组。在巩固，992例患者被随机分配之间的四个疗程与五个疗程，324例患者谁是没有良好的风险被随机分配到移植或化疗作为最终course.ResultsComplete缓解（CR），达到74%的患者和CR没有恢复，达到了额外的11%，8年的总生存率（OS）为38%。除了米托蒽醌组的复发风险（RR）降低外，在任何诱导随机分组之间均未观察到CR、无复发生存期、复发或OS的差异，但CR组的骨髓抑制和死亡增加抵消了复发风险（RR）降低。增加第五个疗程并不能改善OS，可能对老年患者不利。虽然移植降低RR，它并没有改善OS的中危组，但可能是在高危patients.ConclusionSeveral化疗时间表取得了类似的缓解率和OS。四个疗程的化疗是足够的，但除了移植作为最后一个疗程并没有改善OS。需要新的药物，以加强传统的化疗。
PurposeTo optimize treatment for younger patients with acute myeloid leukemia and high-risk myelodys-plastic syndrome by comparing induction options and the number of consolidation courses and whether consolidation should include transplantation.Patients and MethodsWe randomly assigned 1,658 patients younger than age 60 years to receive mitoxantrone/cytarabine/etoposide versus cytarabine/daunorubicin/etoposide and subsequently 1,193 patients to daunorubicin/cytarabine/thioguanine (DAT) where the cytarabine dose was standard (S-DAT) versus double the standard dose (H-DAT). Patients in this randomization were randomly assigned to all-trans-retinoic acid or not. In consolidation, 992 patients were randomly assigned between a total of four courses versus five courses, and 324 patients who were not good risk were randomly assigned to transplantation or chemotherapy as the final course.ResultsComplete remission (CR) was achieved in 74% of patients and CR without recovery was achieved in an additional 11%; overall survival (OS) at 8 years was 38%. No differences in CR, relapse-free survival, relapse, or OS were seen between any of the induction randomizations except for a reduction in relapse risk (RR) on the mitoxantrone arm, which was offset by increased myelosuppression and deaths in CR. The addition of a fifth course did not improve OS and may be detrimental in older patients. Although transplantation reduced RR, it did not improve OS for the intermediate-risk group but was probably of benefit in high-risk patients.ConclusionSeveral chemotherapy schedules achieved similar remission rates and OS. Four courses of chemotherapy are adequate, but the addition of transplantation as a final course does not improve OS. New agents are required to enhance conventional chemotherapy.