Longterm effects of prolonged maintenance and of very early intensification chemotherapy in AML: data from AMLCG
Büchner, T.; Hiddemann, W.; Wörmann, B.; Löffler, H.; Maschmeyer, G.; Hossfeld, D.; Ludwig, W.D.; Nowrousian, M.; Aul, C.; Schaefer, U.W.
Leukemia 6(Suppl 2): 68-71
1992
ISSN/ISBN: 0887-6924 PMID: 1578946 Document Number: 403676
In order to further improve the cure rate in AML we investigated the effect of more chemotherapy--in terms of its intensity and its duration--in 2 studies. In our 1981 study patients received TAD 1-2 courses for induction, 1 course for consolidation and randomly no further treatment or monthly myelosuppressive maintenance for 3 years. Evaluating 213 responders remission duration was clearly longer in the maintenance group with 24% CCR after 5 and 10 years. In our 1985 study the same successful strategy was further intensified by a second induction course given regardless of response to the first course to all patients up to 60 years of age while older patients received standard induction as before. This age-adapted concept resulted in a further increase of 5 years CCR in the 461 responders to as much as 34% not achieved for unselected patients in other multicenter trials. 20 patients receiving auto-BMT in first CR show the same relapse free survival as their counterparts receiving chemotherapy according to the 1985 protocol in a matched-pair analysis. We conclude that both very early intensification and prolonged maintenance contribute to a higher cure rate that is not further improved even by a maximum intensity short-term treatment. The limits of chemotherapy in AML may be overcome by modulating its myelotoxicity and antileukemic potency using GM-CSF as shown in 2 studies of our group.