Updated Results of an Age-Adapted Consolidation Strategy with ABMT (< 50 Years) or High-Dose Ara-C (HiDAC, > 50 Years) in Adult Acute Myeloid Leukemia

Abstract

AML patients in first complete remission (CR) after doxorubicin-cytarabine-thioguanine (DoxAT) chemotherapy were scheduled to receive two early consolidation courses followed by HiDAC (1 g/m²/bd for 6 days) if aged > 50 years or HiDAC plus total body irradiation (TBI) plus ABMT if aged < 50 years. These patients were evaluable after a follow-up of 3.3–8.8 years. Forty-one patients proceeded to ABMT and 24 to the HiDAC cycle (including 5 aged < 50 years), 23 had early consolidation only, 10 relapsed, 2 died very early into remission, 7 were submitted to an allogeneic BMT, and one denied any postremission therapy. For ABMT and HiDAC groups, long-term RFS rate was 53% and 54% (47% for 19 patients aged > 50), respectively. Overall 5-year survival rate was 40% (P < 0.0001), 54% for CR patients, 60% after ABMT, and 65% after HiDAC. Only the presence of hepatosplenomegaly at diagnosis was associated with a significantly worse outcome. The long-term update of this study confirms that it is possible to achieve cure in about one-half of adult AML cases able to receive aggressive postremission consolidation including ABMT or HiDAC.