Long-term follow-up of a randomized post-induction therapy trial in acute myelogenous leukemia (A Southeastern Cancer Study Group Trial)

A phase III clinical trial was designed to determine if more intensive induction and consolidation therapy for acute myeloblastic leukemia increases the remission rate and prolongs survival. A minor objective was to determine if the use of non-cross resistant drugs was more effective than the same drugs used for induction. Patients with untreated leukemia between the ages of 15 and 50 were given daunorubicin 45 mg/m 2 for the first 3 days of a 10-day continuous infusion of cytosine arabinoside, initially at a dose of 200 mg/m 2 but reduced to 100 mg/m 2 because of toxicity. Those under 36 achieving a complete remission and with an histocompatible donor were assigned to a transplant arm. The rest were randomized to receive one of three consolidation arms : A, cytosine arabinoside, 200 mg/m 2 daily for 7 days and daunorubicin 45 mg/m 2 daily for 3 days for three courses ; B, one course as in Arm A followed by amsacrine, 120 mg/m 2 daily for 5 days followed by a 5-day continuous infusion of azacytidine, 150 mg/m 2 /day ; C, thioguanine and cytosine arabinoside, 100 mg/m 2 every 12 h and daunorubicin 10 mg/m 2 daily for 5 days for three courses followed by four maintenance courses of cytosine arabinoside, 100 mg/m 2 daily for 5 days and daunorubicin, 45 mg/m 2 for 2 days every 13 weeks. From 1981 to 1986, 398 eligible patients were enrolled and 219 achieved a complete remission. The initial induction dose of cytosine arabinoside was reduced after five of 29 patients exhibited fatal gastrointestinal toxicity. Only 11 patients were assigned to the transplant arm. There were no significant differences in the consolidation arms. The 5 year disease-free survivals were 38, 31 and 27% in arms A, B, and C respectively. Intensive consolidation therapy with the same or different drugs used in induction was as effective as lower dose consolidation followed by maintenance therapy.