LONG-TERM FOLLOW-UP OF PATIENTS WITH ACUTE MYELOGENOUS LEUKEMIA WHO RECEIVED THE DAUNORUBICIN, VINCRISTINE, AND CYTOSINE-ARABINOSIDE REGIMEN

BACKGROUND. In 1985, the authors published a study of acute myelogenou s leukemia (AML) patients treated with a chemotherapeutic regimen that was then considered intensive. Ten years later, the authors reanalyze d the same cohort to determine whether the very promising actuarial re sults observed at 5 years held after longer follow-up. METHODS. Betwee n 1977 and 1982, 61 patients with AML were treated with a protocol con sisting of daunorubicin, vincristine, and cytosine arabinoside inducti on followed by consolidation and maintenance for a total of 2 years. T he complete remission (CR) rare was 66%, 84% in males versus 47% in fe males (P < 0.005). At the lime of the first analysis in 1984, the over all survival (OS) was 17%, the projected 5-year continuous CR rare (CC R) 32%, and the disease free survival (DFS) rate 29%, with the best re sults observed for males and for patients ages 40-60 years (P < 0.05). RESULTS. When the data were reanalyzed 11 years later in 1995, the re sults were 14% OS, 23% CCR, and 16% DFS at 5 pears. However, these fig ures dropped to 8%, 18%, and 11% at 10 years and to 8%, 12%, and 7% at 15 years, respectively. hmong the 40 CR patients, 31 relapsed (up to 13 years after CR), and all died within 1.6 years after relapse. Nine patients were in CCR: 4 died of unrelated causes (suicide, alcoholic c irrhosis, acute peritonitis, or bladder carcinoma), 1 was lost to foll ow-up after 11 years, 2 were alive and well at 17 years at last follow -up, and 2 were transplanted in first CR and were doing well at 13 and 14 years at last follow-up. The survival advantage for males over fem ales persisted (P = 0.0197), bur the advantage for patients age 40-60 years did not hold. CONCLUSIONS. These long term data indicate that ac tuarial analysis at 5 years map overestimate the cure rate of AML pati ents because a number of late relapses do occur. However, the picture is blurred by the incidence of death not related to leukemia or its tr eatment; and when these patients were censored at the rime of death, 1 7% of CR patients were still projected to be alive and free of leukemi a after 17 years. (C) 1997 American Cancer Society.