AN EFFECTIVE AGE-UNRESTRICTED M-AMSA-BASED 2ND-LINE REGIMEN FOR POOR-PROGNOSIS ACUTE MYELOID-LEUKEMIA

The efficacy and toxicity of a regimen consisting of amsacrine (m-AMSA ), cytarabine, and thioguanine for remission-induction therapy in poor prognosis categories of acute myeloid leukaemia (AML) were determined in a single arm study of 46 patients. The study group consisted of 17 patients with disease refractory to daunorubicin plus cytarabine-base d induction regimens, 22 patients with disease which had relapsed duri ng daunorubicin plus cytarabine maintenance therapy, or following comp letion of this maintenance programme after receiving greater than or e qual to 500 mg daunorubicin/m(2) and 7 previously untreated patients w here cardiac disease contraindicated anthracycline therapy. Complete r emission (CR) was attained in 46%, and probability of survival was com parable to published results for first-line treatment with daunorubici n plus cytarabine regimens. There was no statistically significant dif ference in CR rate or probability of survival between these three cate gories of poor prognosis AML, and cardiotoxic complications were uncom mon despite extensive anthracycline exposure in the majority. In the 4 3% of patients who were 60-76 years of age, there was no statistically significant difference in CR rate or probability of survival relative to patients <60 years. This observation fails to support the view tha t less myelotoxic regimens with lesser efficacy should be the basic ap proach to treatment of AML in patients greater than or equal to 60 yea rs of age.