BENEFIT OF HIGH-DOSE CYTARABINE-BASED CONSOLIDATION CHEMOTHERAPY FOR ADULTS WITH ACUTE MYELOGENOUS LEUKEMIA

Despite consolidation and/or maintenance chemotherapy most patients wi th newly diagnosed acute myelogenous leukemia relapse such that only 2 0-30% survive free of recurrence at five years. To evaluate the long-t erm effects of dose-intensive consolidation, we analysed 123 consecuti ve patients, age 16 to 84 (median 48 years), who received high-dose cy tarabine-based consolidation chemotherapy. After a median follow-up of 88 months (range 26 to 126 months), 38 patients remain alive, with 26 in continued remission from 45 to 126+/- months. Median remission dur ation for all eligible patients is 14 months (range 1.3 to 126 months) and actuarial leukemia-free survival at five years is 24 +/- 8%. Medi an survivalal from remission is 24 months (range 1.3 to 126 months) an d actuarial Survival from remission is 31 +/- 9%. Eighty-two patients (67%) have relapsed with an actuarial risk of relapse of 71 +/- 9% at five years. Adverse prognostic factors were age over 45 and male gende r. When compared to historical controls (P = 0.02), dose-intensive con solidation produced improved leukemia-free survival for patients age < 45, but compliance and enhanced toxicity in the older age groups may l imit further dose intensification.