Current Clinical Practice: Acute Myeloblastic Leukemia: Management with High-Dose Cytosine Arabinoside, Daunorubicin and Marrow Transplantation

Combination high-dose cytosine arabinoside (ARA-C) and daunorubicin (DNR) for primary remission induction of patients with acute myeloblastic leukemia (AML) was evaluated in a single institution study. Patients aged 55 or less with an HLA-sibling received an allogeneic bone marrow transplant (alloBMT) in first remission; other responders were offered autologous BMT (autoBMT). For remission induction 93 patients aged less than 60 received DNR 45mg/m2 BSA×3 and ARA-C 2 gm/m2 BSA every 12 hours for 12 doses; 53 aged 60 or older DNR 25mg/m2daily×3 and ARA-C 1.5–2.0gm/m2 BSA every 12 hours for 12 doses. Consolidation doses of DNR were the same but ARA-C 100mg/m2 BSA/day×5 was given by continuous intravenous infusion. The complete remission rate for patients less than 60 years was 69.9% (95% CI: 59.5–79.0%) and 47.2% (95% CI: 33.3–61.4%) for the older patients. The median duration of first remission for the younger patients was 13.0 months and of overall survival 17.9 months; for patients over 60 years 5.6 and ...