Randomized study of individualized induction therapy with or without vincristine, and of maintenance—intensification therapy between 4 or 12 courses in adult acute myeloid leukemia. AML‐87 study of the Japan adult leukemia study group

Ryuzo Ohno, Tohru Kobayashi, Mitsune Tanimoto, Akira Hiraoka, Kuniyuki Imai, Norio Asou, Masao Tomonaga, Kazuo Tsubaki, Isao Takahashi, Yoshihisa Kodera, Minoru Yoshida, Hirokazu Murakami, Tomoki Naoe, Masanori Shimoyama, Tetsuya Tsukada, Takaaki Takeo, Hirofumi Teshima, Yasusuke Onozawa, Koji Fujimoto, Kazutaka KuriyamaAtsushi Horiuchi, Ikuro Kimura, Saburo Minami, Yasusada Miura, Shinichi Kageyama, Tohru Tahara, Tohru Masaoka, Shigeru Shirakawa, Hidehiko Saito

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Background. It was assessed whether addition of vincristine (VCR) to remission induction therapy would increase the complete remission (CR) rate, and, secondarily, whether 12 courses of maintenance—intensification therapy would produce longer survival than 4 courses in adult acute myeloid leukemia (AML). Methods. A randomized comparison of individualized induction therapy was conducted between daunorubicin, behenoyl cytarabine, 6‐mercaptopurine, and prednisolone with or without VCR. After 3 courses of intensive consolidation therapy, maintenance—intensification therapy was randomized to 4 or 12 courses given every 6 weeks. Results. Of 265 patients registered, 252 were evaluable. CR was obtained in 78%; 80% in 205 patients of age younger than 60 years, and 65% in 47 of age 60 years or older. Addition of VCR reduced the CR rate significantly (84% to 70%, P = 0.007). Predicted 4‐year survival, continuing CR, and disease‐free survival (DFS) rates of 196 CR patients are 45%, 41%, and 35%, respectively. Patients receiving 12 courses of maintenance—intensification showed better DFS. By multivariate analyses, significant factors for achievement of CR were performance status 0 to 2, age younger than 60 years, and no VCR; and those for longer DFS were achievement of CR by one course, age younger than 50 years, and French—American—British (FAB) classification M3 or M5. Among 131 patients randomized to the maintenance, the administration of 12 courses was the most important factor (P = 0.0040) for longer DFS, followed by FAB M3 or M5, and by achievement of CR by one course. Conclusions. Addition of VCR in remission induction therapy was harmful, and longer intensive maintenance therapy prolonged DFS in adult AML.

Original languageEnglish
Pages (from-to)3888-3895
Number of pages8
JournalCancer
Volume71
Issue number12
DOIs
Publication statusPublished - Jun 15 1993

Keywords

  • acute myeloid leukemia
  • adult
  • chemotherapy
  • individualized therapy
  • maintenance therapy
  • randomized study

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Fingerprint Dive into the research topics of 'Randomized study of individualized induction therapy with or without vincristine, and of maintenance—intensification therapy between 4 or 12 courses in adult acute myeloid leukemia. AML‐87 study of the Japan adult leukemia study group'. Together they form a unique fingerprint.

  • Cite this

    Ohno, R., Kobayashi, T., Tanimoto, M., Hiraoka, A., Imai, K., Asou, N., Tomonaga, M., Tsubaki, K., Takahashi, I., Kodera, Y., Yoshida, M., Murakami, H., Naoe, T., Shimoyama, M., Tsukada, T., Takeo, T., Teshima, H., Onozawa, Y., Fujimoto, K., ... Saito, H. (1993). Randomized study of individualized induction therapy with or without vincristine, and of maintenance—intensification therapy between 4 or 12 courses in adult acute myeloid leukemia. AML‐87 study of the Japan adult leukemia study group. Cancer, 71(12), 3888-3895. https://doi.org/10.1002/1097-0142(19930615)71:12<3888::AID-CNCR2820711216>3.0.CO;2-G