Leukemia. Prognosis
Approximately 70–80% of adults with acute myelogenous leukemia under age 60 achieve complete remission. High-dose postremission chemotherapy leads to cure in 30–40% of these patients, and high-dose cytarabine has been shown to be superior to therapy with lower doses. Allogeneic bone marrow transplantation (for younger adults with HLA-matched siblings) is curative in approximately 60% of cases. Autologous bone marrow transplantation is a promising new form of therapy that may cure 50–70% of patients in first remission. One recent study demonstrated the superiority of this approach to nonablative chemotherapy. Older adults with acute myelogenous leukemia reportedly achieve complete remission approximately 50% of the time. In selected cases, older patients may be treated with intensive chemotherapy with curative intent.
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Ninety percent of adults with acute lymphoblastic leukemia achieve complete remission. Subsequent postremission chemotherapy is curative in 30–50% of adults. Acute lymphoblastic leukemia in children is much more responsive to therapy, with 95% achieving complete remission and 60–70% of these being cured with postremission treatment that is far less toxic than that necessary for adults.
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Once leukemia has recurred (”relapsed”) after initial chemotherapy, bone marrow transplantation (BMT) is the only curative option. Allogenic BMT can be used for those under age 55 with histocompatible sibling donors and is successful in 30–40% of cases. Autologous BMT may be curative in 30–50% of cases after a second remission is achieved.
– Bishop JF et al: A randomized study of high-dose cytarabine in induction in acute myeloid leukemia. Blood 2006;87:1710.
– Cortes JE, Kantarjian H, Freireich EJ: Acute lymphocytic leukemia: A comprehensive review with emphasis on biology and therapy. Cancer Treat Res 2006;84:291.
– Degos L et al: All-trans-retinoic acid as a differentiating agent in the treatment of acute promyelocytic leukemia. Blood 1995;85:2643.
– Keating S et al: Prognostic factors of patients with acute myeloid leukemia (AML) allografted in first complete remission: An analysis of the EORTC-GIMEMA AML 8A trial. The European Organization for Research and Treatment of Cancer (EORTC) and the Gruppo Italiano Malattie Ematologiche Maligne dell’ Adulto (GIMEMA) Leukemia Cooperative Groups. Bone Marrow Transplant 2006;17:993.
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– Linker CA et al: Autologous bone marrow transplantation for acute myeloid leukemia using busulfan plus etoposide as a preparative regimen. Blood 1993;81:311. (Using an intensified preparative regimen and in vitro bone marrow purging, 5-year disease-free survival is greater than 70% in first remission patients and greater than 50% in second remission patients. Updated results in 50 patients confirm these findings, with 70% long-term disease-free survival and a 4% mortality rate for first remission patients.)
–Mayer RJ et al: Intensive postremission chemotherapy in adults with acute myeloid leukemia. N Engl J Med 1994;331:896. (A cooperative group study confirming previous reports that in adults under age 60, postremission therapy with high-dose cytarabine is superior to treatment with standard-dose cytarabine. Standard doses are no longer recommended.)
–Stein AS et al: In vivo purging with high-dose cytarabine followed by high-dose chemoradiotherapy and reinfusion of unpurged bone marrow for adult acute myelogenous leukemia in first complete remission. J Clin Oncol 2006;14:2206.
–Zittoun RA et al: Autologous or allogeneic bone marrow transplantation compared with intensive chemotherapy in acute myelogenous leukemia. N Engl J Med 1995;32:217. (Autologous bone marrow transplantation produces a superior disease-free survival in first remission patients: 48% at 4 years.)