Yoshiko Saito1,2*, Yoshiro Uzuka1,Yhuka Takahashi1 and Mari Ohtsuka1
Department of Food and Nutrition, Miyagi Women’s University, JapanFulltext PDF
To date, about 60-80% of adults with previously untreated de novo Acute Myeloid Leukemia (AML) enter Complete Remission (CR) when treated with standard regimen. However, such responses are rarely durable and relapsed when conventional therapy is administered. We aimed to establish a curable treatment protocol because prognosis after relapse is poor and fatal.Over the last decades, progress in treatment for patients with AML, based on risk-directed stratification strategy, had brought large benefit to many patients. On the other hand, our treatment strategy was based on the fact that the assessment of treatment effect might help to define the prognosis of patient and possibly.A total of 88 patients with de novo untreated AML treated between March 1995 and February 2011 was analyzed. Response-based intensive induction chemotherapy: single induction treatment consisted of priming standard regimen and additional induction regimen, which was continuedtill complete clearance of marrow leukemic blasts.Results: By single induction strategy, CR was obtained in 21/21(100 %) of younger patients and in 19/20(95%) of elderly.8-week mortality was 0/21(0%) and1/20(5%) respectively. By an additional chemotherapy course, 8-week mortality was 7/24 (29.2%) in elderly. Differences between the single induction course and an additional courses at univariate analysis were statistically significant for CR (p = 0.0053) and for 8 week mortality (p = 0.0031).Multivariate analysis of prognostic factors identified consistent independent poor prognostic factor for CR, 8-week mortality, and survival. These included age, unfavorable karyotypes, poor performance status, and abnormal organ functions. It was suggested that all risk factors may be overcome by the single induction strategy for patients with AML.There was no co-relationship to the Charlson Comorbidity Index and the 8-week mortality. WT-1 measurements produced a dilemma, AML1/MTG8 and CBFβ/MYH11gene mutation measurement was the result which could be reflected in the chemotherapy.Conclusions: Our unique “response-based single induction strategy” produces high CR rates over 95% and long-term Disease-Free Survival (DFS) over 70%. The intensified treatment was well tolerated in elderly as well as younger patients.
Acute myeloid leukemia; Intensive induction chemotherapy; Blast cell clearance; End point of treatment; Elderly, MRD
Saito Y, Uzuka Y,Takahashi Y, Ohtsuka M. Response-Based Intensive Induction Chemotherapy of Curative Approach in Elderly Acute Myelogenous Leukemia Patients in Single Institution. Clin Oncol. 2017; 2: 1228.