Treatment of acute myeloid leukemia with a combination of intensive induction chemotherapy, early consolidation, splenectomy and long-term maintenance chemotherapy

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Abstract
A therapeutic regimen was developed in which 33 patients aged 11-61 yr (mean .+-. SE; 35.9 .+-. 2.3 yr) with acute myeloid leukemia (AML) were given intensive induction chemotherapy with adriamycin (doxorubicin) (ADM), vincristine (VCR) and cytosine arabinoside (ARA-C). Twenty-nine of these patients (88%) attained a complete remission (CR) after 1, 2, or 3 courses, and were then subjected to an early consolidation course of chemotherapy, identical to that for induction. After consolidation, all patients in CR received a long-term continuous maintenance therapy in which 6-mercaptopurine (6-MP) and methotrexate (MTX) were alternated, associated with periodic reinforcements with daunorubicin (DNR) and VCR. Twenty-five of the 29 patients who achieved a CR were splenectomized soon after the consolidation course. Histologic sections of the spleens, liver biopsy specimens, and lymph nodes, stained routinely and the naphtol AS-D chloroacetate esterase (NCA) method, showed mature granulocytes and a few NCA-positive mononuclear cells, but not proved leukemic infiltrates. For the 25 splenectomized patients, the probability of remaining in CR at 36 and 54 mo. was 75% and 66%, respectively; the probability of survival at 36 and 54 mo. was 85 and 75%, respectively. Age > 40 yr and evidence of extramedullary involvement at presentation to carry a bad prognosis for disease-free survival.