TIMED SEQUENTIAL CHEMOTHERAPY FOR PREVIOUSLY TREATED PATIENTS WITH ACUTE MYELOID-LEUKEMIA - LONG-TERM FOLLOW-UP OF THE ETOPOSIDE, MITOXANTRONE, AND CYTARABINE-86 TRIAL

Purpose: To confirm and extend encouraging preliminary results of time d sequential chemotherapy (TSC) in patients with previously treated ac ute myelogenous leukemia (AML). Patients and Methods: We report the re sults of the regimen of mitoxantrone on days 1 to 3, etoposide on days 8 to 10, and cytarabine on days 1 to 3 and 8 to 10 (EMA) in 133 patie nts, with a median follow-up of 40 months. Results: Sixty percent of p atients, with a 95% confidence interval (CI) ranging from 51% to 68%, achieved complete remission (CR), including 44% (CI, 32% to 57%) of re fractory patients and 96% (CI, 64% to 86%) of late first-relapse patie nts (P = .0002). Twenty-nine percent of patients did not respond to th erapy, and 11% died from toxicity. Median duration of neutropenia and thrombocytopenia was 31 days and 29 days, respectively. Severe nonhema tologic toxicity included sepsis in 54% of patients and mucositis in 2 3%. Postinduction therapy included a second course of EMA in 27 patien ts, maintenance in 10, autologous bone marrow transplantation (BMT) in 12, and allogeneic BMT in 13. Median survival of patients who did not have transplantation performed is 7 months, with 11% (CI, 4% to 18%) survival at 5 years. Median disease-free survival (DFS) is 8 months wi th 20% (CI, 8% to 32%) DFS at 5 years. Twenty-eight percent (CI, 15% t o 44%) of nontransplanted patients who achieved CR had an inversion of CR duration. Previous refractoriness was the main factor associated w ith poor prognosis for CR achievement, DFS, and survival. Conclusion: These results confirm initial reports on TSC and show that approximate ly 20% of patients with first relapse after therapy can enjoy prolonge d DFS using chemotherapy only.