AMSACRINE AND CONTINUOUS-INFUSION HIGH-DOSE CYTOSINE-ARABINOSIDE AS INDUCTION THERAPY FOR PATIENTS WITH NEWLY-DIAGNOSED ACUTE MYELOGENOUS LEUKEMIA

The overall cure rate of adults with newly-diagnosed acute myelogenous leukemia (AML) treated with continuous infusion high-dose cytarabine (CIHDAC) is comparable to that with standard-dose ara-C plus anthracyc line or amsacrine (AMSA). We tested whether the addition of AMSA to CI HDAC improves the outcome of adults with untreated AML. 75 patients wi th untreated AML were treated with AMSA (75 mg/m(2)/day x 4) plus CIHD AC (1.5 g/m(2)/day x 4) for induction and, if in complete remission (C R), early and late intensification. Results were compared to those in 129 patients treated on a previous study with CIHDAC alone. The princi pal comparison in both groups was between those 117 patients (AMSA/CIH DAC n = 52, CIHDAC n = 65) who met the initial eligibility criteria fo r the AMSA/CIHDAC study (risk of early mortality less than or equal to .1) and who were treated at a time when relatively few eligible patien ts were excluded (19% in the AMSA/CIHDAC group, 34% in the CIHDAC grou p). There was no difference between regimens in CR rate, remssion dura tion, or survival in this cohort. When attention was turned to all 204 patients, outcome was superior with AMSA/CIHDAC very largely as a res ult of outcome in patients with APL. Aside from these patients, additi on of amsacrine to CIHDAC did not appear to be productive.