TREATMENT OF PATIENTS WITH ACUTE PROMYELOCYTIC LEUKEMIA - THE EORTC-LCG EXPERIENCE

Acute promyelocytic leukemia (MS) is, as one of the FAB subtypes of AM L, included in the EORTC/GIMEMA AML-8A and 8B randomized trials. In th ese trials 1519 patients were included, 477 of them in non Italian EOR TC-LCG centers and 1042 in GIMEMA centers. A total of 80 patients were classified as MS including 18 patients with MS-variant. Thirty-nine w ere male and 41 female. Ages ranged from 15 to 59 years; 25 (31.3%) of them were younger than 30, 34 (42.5%) between 30 and 45, and 21 (26.3 %) older than 45 years of age. 56.3% of the patients had leukocytes le ss than 5 x 10(9)/l at the time of diagnosis vs. 24.9% of the patients belonging to the other FAB subtypes. Remission induction consisted of a standard protocol with 3 days daunorubicin and 7 days of cytosine a rabinoside. Forty-three patients (53.8%) achieved a complete remission compared to 64.6% of the remaining AML patients. After salvage treatm ent this percentage increased to 70%, which is the same as for the oth er AML subtypes. Thirteen (16.3%) patients died during remission induc tion, mainly due to hemorrhagic complications. This percentage is sign ificantly higher than the death rate (9.1%) in the other FAB subtypes of AML. All patients received one course of consolidation treatment. P ost consolidation treatment could be either standard maintenance, inte nsive consolidation courses, autologous or allogeneic transplantation, according to the guidelines of the treatment protocols. At present, r elapses almost all in the bone marrow, are seen in only 34.9% of the M S patients, compared to 48.4% in the remaining AML patients. Disease-f ree survival for patients less than 45 years of age with the M2 and M3 subtypes was approximately 50% at 3 years compared to 30-40% for the other FAB subtypes. Despite the higher death rate during induction, th e long-term survival results were better for M3 patients in comparison with the remaining AML patients. The projected survival at 3 years wa s 50% for M3 patients vs. 38% for remaining patients.