Progress and survival factors in acute non lymphocytic leukemia. A 15 year analysis

We analyzed a population of adults with acute non lymphocytic leukemia (ANLL) treated from 1972-1989 to identify prognostic factors and the influence of therapy over time. To 179 patients treated at Sunnybrook Medical Centre (SMC) were added 114 patients from published patient series from Princess Margaret Hospital (PMH) all treated during that period. All PMH and 98 SMC patients received one of three remission induction protocols: CAV (cyclophosphamide, cytosine arabinoside [ara-C], vincristine) 1973-1976 (n = 46); ACT (Adriamycin, ara-C +/- 6-thioguanine) 1976-1983 (n = 83); high dose ara-C and corticosteroids 1983-1987 (n = 83). The remainder either received supportive therapy only or minimally toxic therapy (e.g., low dose ara-C, 6-mercaptopurine) due to presenting complications such as advanced age, severe concurrent medical condition, or most recently at SMC only, mitoxanthrone and ara-C, and were excluded from analysis. Responses obtained at the two institutions were identical, no survival advantage of any particular protocol was seen. Overall median survival was 8.5 months for patients treated on protocol and 20 months for those entering complete remission. Patients treated with supportive or minimally toxic therapy (n = 76) had a median survival of less than two months. In multivariate analysis, the only important factors for survival were complete response to initial therapy; complete response to second induction therapy following either first relapse (n = 89) or lack of complete response to first therapy (n = 15); and normal cytogenetic analysis.(ABSTRACT TRUNCATED AT 250 WORDS)