The role of cytosine arabinoside maintenance in acute nonlymphoblastic leukemia

A series of 30 unselected patients with acute nonlymphoblastic leukemia (ANLL) was treated with combination chemotherapy, including three courses of cytosine arabinoside (Ara‐C) by 5‐day continuous i.v. infusion, vincristine i.v. weekly, and prednisone daily to complete remission. Ara‐C was administered alone as a 5‐day continuous i.v. infusion monthly for maintenance. Ten (33%) achieved a complete remission (CR). The remaining 20 (67%), including temporary partial remissions, hematologic improvements, inadequate trials, and early deaths, were all considered failures. The CR rate was 57% in those 17 cases receiving an adequate trial. After 5 1/2 years followup, the overall median survival, including cases failing to achieve CR, was 3.1 months. For those having adequate trials the median survival was 16.6 months, and for those achieving a CR, 36.6 months. Two patients are still alive, one at 55.2 months on maintenance therapy, and the other at 62.8 months, currently unmaintained.