Double induction containing either two courses or one course of high-dose cytarabine plus mitoxantrone and postremission therapy by either autologous stem-cell transplantation or by prolonged maintenance for acute myeloid leukemia
Double induction containing either two courses or one course of high-dose cytarabine plus mitoxantrone and postremission therapy by either autologous stem-cell transplantation or by prolonged maintenance for acute myeloid leukemia
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DOI：
10.1200/jco.2005.04.5013
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发表时间：
2006-06-01
影响因子：
45.3
通讯作者：
Hiddemann, W
中科院分区：
文献类型：
--
作者：
Büchner, T;Berdel, WE;Hiddemann, W
目的急性髓系白血病（AML）缓解后大剂量阿糖胞苷强化治疗或诱导治疗及长期维持治疗是改善预后的有效策略。另外的强化是否能增加这种效果还没有确定。（年龄16 - 85岁）初治或继发性AML或高危骨髓增生异常综合征（MDS）患者被随机分配接受诱导治疗，包括一个标准剂量疗程和一个高剂量阿糖胞苷疗程，或两个高剂量阿糖胞苷疗程，结果60岁以下和≥ 60岁患者的完全缓解率分别为70%和53%。两个年龄组的3年总生存率分别为42%和19%，无复发生存率分别为40%和19%，持续缓解时间分别为48%和22%。两个随机化诱导组之间或两个缓解后治疗组之间的这些结果无显著差异。在任何预后亚组根据继发性AML/MDS，细胞遗传学，白细胞，乳酸脱氢酶，和早期原始细胞clearance.Conclusion方案的一个过程中，标准剂量阿糖胞苷和一个过程中，高剂量阿糖胞苷诱导，并延长维持缓解后化疗的AML患者没有改善额外的升级细胞毒治疗。
Purpose Intensification by high-dose cytarabine in postremission or induction therapy and prolonged maintenance are established strategies to improve the outcome in patients with acute myeloid leukemia (AML). Whether additional intensification can add to this effect has not yet been determined.Patients and Methods A total of 1,770 patients (age 16 to 85 years) with de novo or secondary AML or high-risk myelodysplastic syndrome (MDS) were randomly assigned upfront for induction therapy containing one course with standard dose and one course with high-dose cytarabine, or two courses with high-dose cytarabine, and in the same step received postremission prolonged maintenance or busulfan/cyclophosphamide chemotherapy with autologous stem-cell transplantation.Results The complete remission rate in patients younger than 60 and >= 60 years of age was 70% and 53%, respectively. The overall survival at 3 years in the two age groups was 42% and 19%, the relapse-free survival was 40% and 19%, and the ongoing remission duration was 48% and 22%, respectively. There were no significant differences in these results between the two randomized induction arms or between the two postremission therapy arms. There was no significant difference in any prognostic subgroup according to secondary AML/MDS, cytogenetics, WBC, lactate dehydrogenase, and early blast clearance.Conclusion The regimen of one course with standard-dose cytarabine and one course with high-dose cytarabine for induction, and prolonged maintenance for postremission chemotherapy in patients with AML is not improved by additional escalation in cytotoxic treatment.