TREATMENT OF ACUTE PROMYELOCYTIC LEUKEMIA IN PATIENTS PRESENTING AT VANCOUVER-GENERAL-HOSPITAL FROM 1983 TO 1992

Between 6/83 and 8/92, 23 of 361 patients (6.4%) presenting at Vancouv er General Hospital with acute myelogenous leukemia had acute promyelo cytic leukemia (APL). Treatment plan was: 1) induction with high-dose cytosine arabinoside and an intercalator; and 2) consolidation with al logeneic bone marrow transplantation (BMT) for those aged less than or equal to 50 years with a sibling donor or repeat of induction for the others. Complete remission (CR) was achieved in 20 patients (87%). El even patients in CR were eligible for allogeneic BMT; 4 were considere d unsuitable, 2 refused, and 5 underwent this treatment-1 died of acut e graft-versus-host disease, 1 relapsed and 3 are leukemia-free and we ll 1.6, 3.3 and 3.9 years after diagnosis. Fifteen patients did not un dergo allogeneic BMT in CR; 4 received no further treatment and all di ed, 2 relapsed before consolidation therapy and both died, 1 underwent autologous BMT and died of complications, and 8 received consolidatio n treatment as planned-1 died of sepsis, 2 relapsed and 5 are leukemia -free and well 1.0, 3.8, 4.5, 4.9 and 8.5 years after diagnosis. The a ctuarial overall survival for all 23 patients was 38% (95% confidence interval [CI] 18-57%). The actuarial 2-year leukemia-free survival was 60% (95% CI 20-85%) for the 8 patients who underwent consolidation ch emotherapy as planned and 53% (95% CI 68-86%) for the 5 patients who u nderwent allogeneic BMT in CR. These results suggest that patients wit h APL who are able to undergo consolidation chemotherapy have a relati vely good prognosis and allogeneic BMT may reasonably be held in reser ve for salvage therapy.