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

R. Ohno, T. Kobayashi, M. Tanimoto, A. Hiraoka, K. Imai, N. Asou, M. Tomonaga, K. Tsubaki, I. Takahashi, Y. Kodera, M. Yoshida, H. Murakami, T. Naoe, M. Shimoyama, T. Tsukada, T. Takeo, H. Teshima, Y. Onozawa, K. Fujimoto

Research output: Contribution to journalArticle

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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
Publication statusPublished - 1993
Externally publishedYes

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Vincristine
Acute Myeloid Leukemia
Japan
Leukemia
Maintenance
Disease-Free Survival
Remission Induction
enocitabine
Therapeutics
6-Mercaptopurine
Daunorubicin
Survival
Prednisolone
Multivariate Analysis
Survival Rate

Keywords

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

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

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. / 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.

In: Cancer, Vol. 71, No. 12, 1993, p. 3888-3895.

Research output: Contribution to journalArticle

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 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, vol. 71, no. 12, pp. 3888-3895.
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. / 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. In: Cancer. 1993 ; Vol. 71, No. 12. pp. 3888-3895.
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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.",
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TY - JOUR

T1 - 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

T2 - AML-87 study of the Japan adult leukemia study group

AU - Ohno, R.

AU - Kobayashi, T.

AU - Tanimoto, M.

AU - Hiraoka, A.

AU - Imai, K.

AU - Asou, N.

AU - Tomonaga, M.

AU - Tsubaki, K.

AU - Takahashi, I.

AU - Kodera, Y.

AU - Yoshida, M.

AU - Murakami, H.

AU - Naoe, T.

AU - Shimoyama, M.

AU - Tsukada, T.

AU - Takeo, T.

AU - Teshima, H.

AU - Onozawa, Y.

AU - Fujimoto, K.

PY - 1993

Y1 - 1993

N2 - 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.

AB - 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.

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KW - adult

KW - chemotherapy

KW - individualized therapy

KW - maintenance therapy

KW - randomized study

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