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

The authors developed a therapeutic regimen in which 33 patients aged 11 to 61 years (mean ± SE, 35.9 ± 2.3 years) 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 with the naphtol AS‐D chloroacetate esterase (NCA) method, showed mature granulocytes and a few NCA positive mononuclear cells, but no proved leukemic infiltrates. For the 25 splenectomized patients, the probability of remaining in CR at 36 and 54 months was 75% and 66%, respectively; the probability of survival at 36 and 54 months was 85% and 75%, respectively. Age older than 40 years and evidence of extramedullary involvement at presentation appeared to carry a bad prognosis for disease‐free survival.