Benefit of high-dose cytarabine-based consolidation chemotherapy for adults with acute myelogenous leukemia

Despite consolidation and/or maintenance chemotherapy most patients with newly diagnosed acute myelogenous leukemia relapse such that only 20-30% survive free of recurrence at five years. To evaluate the long-term effects of dose-intensive consolidation, we analysed 123 consecutive patients, age 16 to 84 (median 48 years), who received high-dose cytarabine-based consolidation chemotherapy. After a median follow-up of 88 months (range 26 to 126 months), 38 patients remain alive, with 26 in continued remission from 45 to 126+ months. Median remission duration for all eligible patients is 14 months (range 1.3 to 126 months) and actuarial leukemia-free survival at five years is 24 ± 8% Median survival from remission is 24 months (range 1.3 to 126 months) and actuarial survival from remission is 31 ± 9% Eighty-two patients (67% have relapsed with an actuarial risk of relapse of 71 ± 9% at five years. Adverse prognostic factors were age over 45 and male gender. When compared to historical controls (P = 0.02), dose-intensive consolidation produced improved leukemia-free survival for patients age <45, but compliance and enhanced toxicity in the older age groups may limit further dose intensification.