Age and cytogenetics as predictors of event free survival in patients withacute non-lymphocytic leukemia receiving high dose cytosine arabinoside and daunorubicin as consolidation chemotherapy

Between 1991 and 1999, 67 patients with acute non-lymphocytic leukemia (ANL L) in complete remission received high dose cytarabine (HiDAC) 3 gm/m(2) q1 2h x 12 doses followed by daunorubicin 45 mg/m(2)/day x 3 days as consolida tion therapy. Five year actuarial event free survival (EFS) was 34% +/- 6%. Age was significantly associated with EFS. EFS was 60% +/- 15% in patients age 20 to 29, 48% +/- 16% in patients age 30 to 39, 23% +/- 10% in patient s age 40 to 49, 31% +/- 11% in patients age 50 to 59, and 0% in patients ag e greater than or equal to 60. Contrary to other reports which have used di fferent HiDAC regimens, we found no relationship between cytogenetics and E FS. Cytogenetics were defined as favorable risk: t(8;21), inv (16), and del (16); neutral risk: normal or t(15;17); and unfavorable risk: any abnormal ity not included in favorable risk or neutral risk. EFS was 29% +/- 17% in patients with favorable cytogenetics, 37% +/- 14% in patients with neutral cytogenetics, and 31% +/- 12% in patients with unfavorable cytogenetics. Th ese differences were not statistically significant. Because of the successf ul use of allogeneic transplantation at relapse in patients with matched re lated donors, five year actuarial survival (S) in this series was 40% +/- 6 %. Five year actuarial survival was 57% +/- 9% for patients age : 44 and 25 % +/- 8% for patients age greater than or equal to 45. This difference is s tatistically significant, p < .025. Clinicians should be cautious about mak ing clinical decisions regarding consolidation therapy of ANLL on the basis of the presence or absence of cytogenetic abnormalities as the importance of cytogenetics may depend on the specific therapy which is employed.