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. 1977 Apr;126(4):267–272.

Remission Maintenance Therapy in Acute Myelogenous Leukemia

Stephen H Embury 1, Laurence Elias 1, Philip H Heller 1, Charles E Hood 1, Peter L Greenberg 1, Stanley L Schrier 1
PMCID: PMC1237541  PMID: 266313

Abstract

Because no conclusive evidence as to the efficacy of maintenance chemotherapy in acute myelogenous leukemia (AML) existed, a study to obtain such information was done. Twenty-six adult patients with AML in whom complete remission had been achieved following induction chemotherapy were randomly assigned to receive either maintenance chemotherapy consisting of cytarabine and 6-thioguanine for two days each month or to receive no maintenance therapy. The data showed a significant difference in remission duration between the two groups, with median remission lengths for the maintained and unmaintained groups being 10.3 and 6.7 months, respectively (p<.05). In 46 percent of the maintained patients there were remissions lasting longer than 11 months, whereas in none of the unmaintained patients was there such a prolonged remission. No significant drug-induced toxicity was observed. That the prolonged exposure to these chemotherapeutic agents, which were also used in our induction program, did not adversely affect the rate of successful reinduction therapy was shown by identical 50 percent complete remission rates for second inductions in both groups. In patients with palpable splenomegaly at the time of diagnosis, there was no prolongation of remission with maintenance therapy. These data indicate the potential utility of maintenance chemotherapy for prolonging remission duration in acute myelogenous leukemia.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bodey G. P., Coltman C. A., Freireich E. J., Bonnet J. D., Gehan E. A., Haut A. B., Hewlett J. S., McCredit K. B., Saiki J. H., Wilson H. E. Chemotherapy of acute leukemia. Comparison of cytarabine alone and in combination with vincristine, prednisone, and cyclophosphamide. Arch Intern Med. 1974 Feb;133(2):260–266. doi: 10.1001/archinte.133.2.260. [DOI] [PubMed] [Google Scholar]
  2. Bodey G. P., Freireich E. J., Gehan E., McCredie K. B., Rodriguez V., Gutterman J., Burgess M. A. Late intensification therapy for acute leukemia in remission. Chemotherapy and immunotherapy. JAMA. 1976 Mar 8;235(10):1021–1025. [PubMed] [Google Scholar]
  3. Burge P. S., Prankerd T. A., Richards J. D., Sare M., Thompson D. S., Wright P. Quality and quantity of survival in acute myeloid leukaemia. Lancet. 1975 Oct 4;2(7936):621–624. doi: 10.1016/s0140-6736(75)90111-7. [DOI] [PubMed] [Google Scholar]
  4. Clarkson B. D. Acute myelocytic leukemia in adults. Cancer. 1972 Dec;30(6):1572–1582. doi: 10.1002/1097-0142(197212)30:6<1572::aid-cncr2820300624>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  5. Clarkson B. D., Dowling M. D., Gee T. S., Cunningham I. B., Burchenal J. H. Treatment of acute leukemia in adults. Cancer. 1975 Aug;36(2):775–795. doi: 10.1002/1097-0142(197508)36:2+<775::aid-cncr2820360824>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  6. Ellison R. R., Holland J. F., Weil M., Jacquillat C., Boiron M., Bernard J., Sawitsky A., Rosner F., Gussoff B., Silver R. T. Arabinosyl cytosine: a useful agent in the treatment of acute leukemia in adults. Blood. 1968 Oct;32(4):507–523. [PubMed] [Google Scholar]
  7. Fairbanks V. F., Shanbrom E., Steinfeld J. L., Beutler E. Prolonged remissions in acute myelocytic leukemia in adults. JAMA. 1968 May 13;204(7):574–579. [PubMed] [Google Scholar]
  8. Fleming I., Simone J., Jackson R., Johnson W., Walters T., Mason C. Proceedings: Splenectomy and chemotherapy in acute myelocytic leukemia of childhood. Cancer. 1974 Feb;33(2):427–434. doi: 10.1002/1097-0142(197402)33:2<427::aid-cncr2820330218>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  9. Frei E., 3rd Combination cancer therapy: Presidential address. Cancer Res. 1972 Dec;32(12):2593–2607. [PubMed] [Google Scholar]
  10. GEHAN E. A. A GENERALIZED WILCOXON TEST FOR COMPARING ARBITRARILY SINGLY-CENSORED SAMPLES. Biometrika. 1965 Jun;52:203–223. [PubMed] [Google Scholar]
  11. Gee T. S., Yu K. P., Clarkson B. D. Treatment of adult acute leukemia with arabinosylcytosine and thioguanine. Cancer. 1969 May;23(5):1019–1032. doi: 10.1002/1097-0142(196905)23:5<1019::aid-cncr2820230506>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  12. Greenberg P., Bax I., Mara B., Schrier S. Alterations of granulopoiesis following chemotherapy. Blood. 1974 Sep;44(3):375–383. [PubMed] [Google Scholar]
  13. Grozea P. N., Bottonley R. H., Shaw M. T., Tu H., Chanes R. E., Condit P. T. The role of cytosine arabinoside maintenance in acute nonlymphoblastic leukemia. Cancer. 1975 Sep;36(3):855–860. doi: 10.1002/1097-0142(197509)36:3<855::aid-cncr2820360304>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  14. HEWLETT J. S., BATTLE J. D., Jr, BISHOP R. C., FOWLER W. M., SCHWARTZ S. O., HAGEN P. S., LOUIS J. PHASE II STUDY OF A-8103 (NSC-25154) IN ACUTE LEUKEMIA IN ADULTS. Cancer Chemother Rep. 1964 Nov;42:25–28. [PubMed] [Google Scholar]
  15. Jacquillat C., Weil M., Gemon M. F., Izrael V., Schaison G., Auclerc G., Ablin A. R., Flandrin G., Tanzer J., Bussel A. Evaluation of 216 four-year survivors of acute leukemia. Cancer. 1973 Aug;32(2):286–293. doi: 10.1002/1097-0142(197308)32:2<286::aid-cncr2820320202>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  16. Jacquillat C., Weil M., Tanzer J., Bussel A., Loisel J. P., Goguel A., Schaison G., Najean Y., Goudemand M., Seligmann M. Les très longues rémissions complètes des leucémies aiguës. A propos de 65 observations de leucémies aiguës dont la durée a dépassé 4 ans. Presse Med. 1970 Jan 31;78(6):253–256. [PubMed] [Google Scholar]
  17. Poth J. L., Johnson P. K., George R. P., Jr, Schrier S. L. Therapy of acute myelocytic leukemia. Daunomycin contrasted with a combination of cytosine arabinoside and 6-thioguanine. Calif Med. 1972 Dec;117(6):1–11. [PMC free article] [PubMed] [Google Scholar]
  18. Powles R. L. Immunotherapy in the management of acute leukaemia. Br J Haematol. 1976 Feb;32(2):145–149. doi: 10.1111/j.1365-2141.1976.tb00916.x. [DOI] [PubMed] [Google Scholar]
  19. Saunders E. F., Lampkin B. C., Mauer A. M. Variation of proliferative activity in leukemic cell populations of patients with acute leukemia. J Clin Invest. 1967 Aug;46(8):1356–1363. doi: 10.1172/JCI105628. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Simone J. Acute lymphocytic leukemia in childhood. Semin Hematol. 1974 Jan;11(1):25–39. [PubMed] [Google Scholar]
  21. Skipper H. E., Schabel F. M., Jr, Wilcox W. S. Experimental evaluation of potential anticancer agents. XXI. Scheduling of arabinosylcytosine to take advantage of its S-phase specificity against leukemia cells. Cancer Chemother Rep. 1967 Jun;51(3):125–165. [PubMed] [Google Scholar]
  22. Steuart C. D., Burke P. J. Cytidine deaminase and the development of resistance to arabinosyl cytosine. Nat New Biol. 1971 Sep 22;233(38):109–110. doi: 10.1038/newbio233109a0. [DOI] [PubMed] [Google Scholar]
  23. Till M. M., Hardisty R. M., Pike M. C. Long survivals in acute leukaemia. Lancet. 1973 Mar 10;1(7802):534–538. doi: 10.1016/s0140-6736(73)90342-5. [DOI] [PubMed] [Google Scholar]
  24. Viola M. V., Frazier M., Wiernik P. H., McCredie K. B., Spiegelman S. Reverse transcriptase in leukocytes of leukemic patients in remission. N Engl J Med. 1976 Jan 8;294(2):75–80. doi: 10.1056/NEJM197601082940203. [DOI] [PubMed] [Google Scholar]

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