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| Attempts to improve treatment outcomes in acute myeloid leukemia (AML) in older patients: the results of the United Kingdom Medical Research Council AML11 trial |
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| Author(s): Goldstone AH, Burnett AK, Wheatley K, Smith AG, Hutchinson RM, Clark RE |
| Source: BLOOD Volume: 98 Issue: 5 Pages: 1302-1311 Published: SEP 1 2001 |
| Times Cited: 147 References: 37 |
| Abstract: In an attempt to improve induction chemotherapy for older patients with acute myeloid leukemia (AML), 1314 patients were randomized to 1 of 3 induction treatments for 2 courses of DAT (daunorubicin, cytarabine, and thioguanine) 3 + 10, ADE (daunorubicin, cytarabine, and etoposide) 10 + 3 + 5, or MAC (mitoxantronecytarabine). The remission rate In the DAT arm was significantly better than AIDE (62% vs 50%; P = .002) or MAC (62% vs 55%; P = .04). This benefit was seen in patients younger and older than 70 years. There were no differences between the induction schedules with respect to overall survival at 5 years (12% vs 8% vs 10%). A total of 226 patients were randomized to receive granulocyte colony-stimulating factor (G-CSF) or placebo as supportive care from day 8 after the end of treatment course 1. The remission rate or survival were not improved by G-CSF, although the median number of days to recover neutrophils to 1.0 x 10(9)/L was reduced by 5 days. Patients who entered remission (n = 371) were randomized to stop after a third course (DAT 2 + 7) or after 6 courses, le, a subsequent COAP (cyclophosphamide, vincristine, cytarabine, and prednisolone), DAT 2 + 5, and COAP. The relapse risk (81% VS 73%), disease-free survival (16% vs; 23%), and overall survival at 5 years (23% vs 22%) did not differ between the 3-course or 6-course arms. In addition to a treatment duration randomization, 362 patients were randomized to receive 12-month maintenance treatment with low-dose interferon, but no benefit was seen with respect to relapse risk, disease-free survival, or overall survival. (C) 2001 by The American Society of Hematology. |
| Document Type: Article |
| Language: English |
| Reprint Address: Burnett, AK (reprint author), Cardiff Univ, Dept Haematol, Heath Pk, Cardiff CF14 4XN, S Glam Wales |
Addresses:
1. Cardiff Univ, Dept Haematol, Cardiff CF14 4XN, S Glam Wales
2. UCL Hosp, Dept Haematol, London WC1E 6AU, England
3. Univ Birmingham, Birmingham Clin Trials Unit, Birmingham B15 2TT, W Midlands England
4. Southampton Univ NHS Trust, Dept Haematol, Southampton, Hants England
5. Leicester Royal Infirm, Dept Haematol, Leicester, Leics England
6. Royal Liverpool Hosp, Dept Haematol, Liverpool L7 8XP, Merseyside England |
| Publisher: AMER SOC HEMATOLOGY, 1900 M STREET. NW SUITE 200, WASHINGTON, DC 20036 USA |
| Subject Category: Hematology |
| IDS Number: 467DH |
| ISSN: 0006-4971 |
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