PROGRESS IN MANAGEMENT OF ACUTE MYELOID-LEUKEMIA (AML) IN AUSTRALIA SINCE 1980 - A SINGLE INSTITUTION RETROSPECTIVE STUDY

Background: Much research has been conducted into the pathobiology, di agnosis, and management of acute myeloid leukaemia (AML) since 1980, w ith major contributions from Australian studies in this period. Aims: To determine whether advances in basic and clinical research into AML have translated into improved survival for patients in the community. Methods: A retrospective survey of records of all patients with AML pr esenting to the Royal Melbourne Hospital (RMH) over a 16 year period, analysed according to induction therapy and established prognostic fac tors. Between 1980 and December 1996 223 (98%) of 227 patients were ev aluable. Results: The probability of survival at five years for patien ts treated since 1990 has improved significantly compared to the cohor t treated between 1980-89 (34+/-5% vs 4+/-2%; mean+/-standard error). This benefit is most evident in patients less than 60 years of age (50 +/-7% vs 11+/-4%). Successive induction protocols in the context of cl inical trials conducted since 1985 contributed to improved outcomes. T he selective application of bone marrow transplantation, and use of re tinoic acid as induction therapy for acute promyelocytic leukaemia has also improved survival. Despite increases in dose-intensity, early de ath rates for patients undergoing induction therapy fell during the st udy period.Conclusions: Participation in clinical and basic research w ith the development of more intense and specific treatments for patien ts with AML has contributed to better outcomes, underpinned by improve ments in supportive care.