GM-CSF, ARA-C, VP-16 and idarubicin (GM-IVA), a short, and effective induction treatment for de novo AML, suitable for the elderly

GM-IVA is a short and effective induction therapy of non M3 de novo AML inc luding GM-CSF (300 mcg 12 hrs before starting therapy), Ara-C (250 mg/sqm c . i. x 3 days), VP16 (100 mg/sqm x 3 days) and idarubicin (12 mg/sqm x 3 da ys); it was followed by a fludarabine containing salvage protocol (FLANG), Patients < 60 years of age achieving CR received 2 courses of FLANG and aut ologous or allogeneic BMT when possible. Patients > 60 years of age in CR r eceived a second course of GM-IVA. Twenty-one consecutive patients (mean ag e 64, range 29-85) entered the study. Three patients (14%) died during indu ction therapy. After one course of GMIVA, CR was achieved in 12 patients (5 7%), Two further patients were salvaged with FLANG therapy so that the fina l CR rate was 14/21 (67%), In elderly patients the final CR rate (62%) is n oteworthy, considering that 6 patients were > 70 years of age and 3 were > 80. All three patients > 80 achieved CR (lasting 5 to 7 months). The median time of granulocyte and platelet recovery was 15 days. Our scheme was well tolerated. In the group of elderly patients 3 out of 14 died during induct ion (21%) and 4 life-threatening infections were observed (28%). The short duration of cytotoxic therapy and perhaps the use of G-CSF contributed to a reduction of the hospitalization period (median of 22 days), thus providin g major savings on induction costs and allowing for better utilization of b eds as well as significantly improving patients' quality of life.