Multivariate analysis of factors associated with outcome of treatment for adults with acute myelogenous leukemia

• Published in: Cancer 1984-10, Vol.54 (8), p.1672-1681
• Main Authors: Schwartz, Richard S., Mackintosh, F. Roy, Halpern, Jerry, Schrier, Stanley L., Greenberg, Peter L.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Alkaline Phosphatase - blood; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Doxorubicin - administration & dosage; Female; Hematologic and hematopoietic diseases; Humans; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - mortality; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Leukocyte Count; Male; Medical sciences; Middle Aged; Mitolactol - administration & dosage; Prognosis; Regression Analysis; Splenomegaly - complications; Tamoxifen - administration & dosage; Time Factors
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(19841015)54:8<1672::AID-CNCR2820540831>3.0.CO;2-F

Utilizing multivariate logistic regression statistical analysis, the authors evaluated prognostic features associated with achievement of complete remission (CR) and remission and survival duration in acute myelogenous leukemia (AML). These clinical variables were analyzed in 77 consecutive adult patients who underwent 108 courses of remission induction therapy with daunomycin, cytosine arabinoside, and 6‐thioguanine (DAT) chemotherapy for newly diagnosed and first relapse of AML. Eight patients had developed leukemia in the setting of other malignant or immunologic diseases (therapy‐linked AML) and 69 patients had not (primary AML). Sixty‐three percent of patients with primary AML achieved CR with median remission and survival durations of 11 and 24 months, respectively. Significant unfavorable predictive features for achievement of CR were splenomegaly, and elevated leukocyte count or serum alkaline phosphatase levels. Patients who had leukocyte counts of ≤10,000/mm3 at diagnosis or ≤40,000/ mm3 at the start of therapy, and those who received >120 mg/m2 of daunomycin had significantly longer remissions and survival than those who did not. Fifty‐seven percent of patients in first relapse also achieved CR however, relative to first remissions, second remission durations were significantly shorter (median, 4.6 months). Sixty‐two percent of patients with therapy‐linked AML achieved CR, but remission durations (median, 2.8 months) were significantly shorter than first remissions of primary AML patients. These data identify clinical features associated with increased risk of failure to achieve CR and potential for short remission duration and survival. Alternative forms of therapy should be considered for such high‐risk patients.