Intensive Induction Therapy with Behenoyl, Cytosine Arabinoside, Daunorubicin, and 6-Mercaptopurine Followed by Intensive Consolidation with Mitoxantrone, Etoposide, Vincristine, and Intermediate-Dose Continuous Cytarabine (M-85 Protocol) for Adult Acute Myelogenous Leukemia

Over 70% of adults with acute myelogenous leukemia (AML) are induced into complete remission (CR) [1-4]. Our current target is not only to increase the remission rate, but to increase the cure rate of this disease, hopefully to over 50%. Two previous protocols for adult AML in our hospitals, BHACDMP [2] and BHAC-DMP (II) [4], from 1979 to 1985 showed that the percentage of blasts in the bone marrow at 2 weeks after the start of therapy is the most significant prognostic factor for predicting longer continuing CR by a multivariate analysis. However, in BHAC-DMP (II), where we gave very intensive induction therapy to reduce blasts in the marrows as quickly as possible, we were forced to stop this protocol because of a high incidence of severe infections, especially aspergillosis and other fungal infections, owing to prolonged myelosuppression during the induction period.