Effect of aggressive daunomycin therapy on survival in acute promyelocytic leukemia

D. Head, K. J. Kopecky, J. Weick, J. C. Files, D. Ryan, K. Foucar, M. Montiel, J. Bickers, A. Fishleder, M. Miller, C. Spier, C. Hanson, M. Bitter, R. Braziel, G. Mills, Jeanna L Welborn, W. Williams, J. Hewlett, C. Willman, F. R. Appelbaum

Research output: Contribution to journalArticle

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Abstract

The Southwest Oncology Group analyzed outcome with cytotoxic chemotherapy for previously untreated acute myeloblastic leukemia (AML) from 1982 through 1986. Results with acute promyelocytic leukemia (APL) prompted comparison with patients from 1986 through 1991 and analysis of factors contributing to APL results. Patient and disease characteristics and treatment outcome were compared for all evaluable patients, with more detailed analysis of factors affecting APL treatment outcome. From 1982 through 1986, median survival and disease-free survival in 45 APL patients were 106 months and greater than 105 months, respectively, versus 6 and 14 months for 417 other AML patients. Such differences were not seen from 1986 through 1991. In the 141 APL patients from 1982 through 1991, after adjusting for significant patient and disease characteristics, higher daunomycin (DNR) doses during induction were significantly associated with higher complete remission rates (P < .0001), longer survival (P < .0001), and longer DFS (P < .0001). Cytosine arabinoside (Ara-C) induction dose, the inclusion of other chemotherapy agents in induction, postremission therapy (consolidation, maintenance, or bone marrow transplantation) other than DNR, APL subtype, and patient age did not appear to significantly affect outcome of APL, except for a significant detrimental effect of high-dose Ara-C in consolidation (P = .0042). Morphologic AML subtypes other than APL did not affect outcome. We conclude that high-dose DNR selectively increases survival in APL. This good survival is important for evaluation of combined all-trans retinoic acid (ATRA)/chemotherapy protocols and for planning future combinations of chemotherapy and ATRA. These results illustrate the need to individualize chemotherapy for subtypes of AML. Therapeutic response of APL is independent of age. Except for APL, morphologic subclassification of AML contributed little prognostic information.

Original languageEnglish (US)
Pages (from-to)1717-1728
Number of pages12
JournalBlood
Volume86
Issue number5
StatePublished - Sep 1 1995
Externally publishedYes

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Acute Promyelocytic Leukemia
Daunorubicin
Chemotherapy
Cytarabine
Survival
Acute Myeloid Leukemia
Tretinoin
Consolidation
Therapeutics
Oncology
Drug Therapy
Statistical Factor Analysis
Bone
Planning
Combination Drug Therapy
Bone Marrow Transplantation
Disease-Free Survival
Maintenance

ASJC Scopus subject areas

  • Hematology

Cite this

Head, D., Kopecky, K. J., Weick, J., Files, J. C., Ryan, D., Foucar, K., ... Appelbaum, F. R. (1995). Effect of aggressive daunomycin therapy on survival in acute promyelocytic leukemia. Blood, 86(5), 1717-1728.

Effect of aggressive daunomycin therapy on survival in acute promyelocytic leukemia. / Head, D.; Kopecky, K. J.; Weick, J.; Files, J. C.; Ryan, D.; Foucar, K.; Montiel, M.; Bickers, J.; Fishleder, A.; Miller, M.; Spier, C.; Hanson, C.; Bitter, M.; Braziel, R.; Mills, G.; Welborn, Jeanna L; Williams, W.; Hewlett, J.; Willman, C.; Appelbaum, F. R.

In: Blood, Vol. 86, No. 5, 01.09.1995, p. 1717-1728.

Research output: Contribution to journalArticle

Head, D, Kopecky, KJ, Weick, J, Files, JC, Ryan, D, Foucar, K, Montiel, M, Bickers, J, Fishleder, A, Miller, M, Spier, C, Hanson, C, Bitter, M, Braziel, R, Mills, G, Welborn, JL, Williams, W, Hewlett, J, Willman, C & Appelbaum, FR 1995, 'Effect of aggressive daunomycin therapy on survival in acute promyelocytic leukemia', Blood, vol. 86, no. 5, pp. 1717-1728.
Head D, Kopecky KJ, Weick J, Files JC, Ryan D, Foucar K et al. Effect of aggressive daunomycin therapy on survival in acute promyelocytic leukemia. Blood. 1995 Sep 1;86(5):1717-1728.
Head, D. ; Kopecky, K. J. ; Weick, J. ; Files, J. C. ; Ryan, D. ; Foucar, K. ; Montiel, M. ; Bickers, J. ; Fishleder, A. ; Miller, M. ; Spier, C. ; Hanson, C. ; Bitter, M. ; Braziel, R. ; Mills, G. ; Welborn, Jeanna L ; Williams, W. ; Hewlett, J. ; Willman, C. ; Appelbaum, F. R. / Effect of aggressive daunomycin therapy on survival in acute promyelocytic leukemia. In: Blood. 1995 ; Vol. 86, No. 5. pp. 1717-1728.
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abstract = "The Southwest Oncology Group analyzed outcome with cytotoxic chemotherapy for previously untreated acute myeloblastic leukemia (AML) from 1982 through 1986. Results with acute promyelocytic leukemia (APL) prompted comparison with patients from 1986 through 1991 and analysis of factors contributing to APL results. Patient and disease characteristics and treatment outcome were compared for all evaluable patients, with more detailed analysis of factors affecting APL treatment outcome. From 1982 through 1986, median survival and disease-free survival in 45 APL patients were 106 months and greater than 105 months, respectively, versus 6 and 14 months for 417 other AML patients. Such differences were not seen from 1986 through 1991. In the 141 APL patients from 1982 through 1991, after adjusting for significant patient and disease characteristics, higher daunomycin (DNR) doses during induction were significantly associated with higher complete remission rates (P < .0001), longer survival (P < .0001), and longer DFS (P < .0001). Cytosine arabinoside (Ara-C) induction dose, the inclusion of other chemotherapy agents in induction, postremission therapy (consolidation, maintenance, or bone marrow transplantation) other than DNR, APL subtype, and patient age did not appear to significantly affect outcome of APL, except for a significant detrimental effect of high-dose Ara-C in consolidation (P = .0042). Morphologic AML subtypes other than APL did not affect outcome. We conclude that high-dose DNR selectively increases survival in APL. This good survival is important for evaluation of combined all-trans retinoic acid (ATRA)/chemotherapy protocols and for planning future combinations of chemotherapy and ATRA. These results illustrate the need to individualize chemotherapy for subtypes of AML. Therapeutic response of APL is independent of age. Except for APL, morphologic subclassification of AML contributed little prognostic information.",
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