Timed-sequential induction therapy improves postremission outcome in acute myeloid leukemia: a report from the Children's Cancer Group

摘要: Timed sequencing of cycles induction chemotherapy in acute myeloid leukemia (AML) has been proposed as a way to achieve maximal leukemic cell kill through recruitment and synchronization residual neoplastic cells. Furthermore, whether intensive therapy should be continued the presence profound myelosuppression is an important question. The Children's Cancer Group (CCG) conducted prospective randomized trial which 589 patients with AML were at diagnosis one two approaches involving 4-day cycle five active chemotherapeutic agents, second administered either 10 days after first cycle, despite low or dropping blood counts (intensive timing), 14 later from beginning depending on bone marrow status (standard timing). All achieving remission received total four therapy. They then allocated allogeneic transplantation (BMT) if compatible family donor was present aggressive nonmyeloablative myeloablative purged autologous BMT rescue. three postremission arms remain coded. Induction success median complete similar for 295 timing arm (75%, 99 days) compared 294 standard (70%, 105 days; P = .18 remission). However, marked improvement outcome demonstrated arm, actuarial event-free survival 3 years 42% +/- 7% (95% confidence interval [CI]) versus 27% 6% (P .0005). Disease-free results end superior receiving intensively timed (N 211), 55% 9% 37% 195, .0002), follow-up 28 months. Superior documented irrespective they allocated. Intensively markedly improves survival, even undergoing Without controlling type received, various studies comparing different preparative regimens will difficult interpret.