[Individualisation of therapy in acute nonlymphoblastic leukaemia]

Acute nonlymphoblastic leukaemia involves the dynamic and individual coupling of four groups of significant prognostic factors: biological potential of the patient, leukaemic clone, normal haematopoiesis, and therapy. The active, dynamic, and timely prognosis of an unfavourable outcome represents a solid basis for the individual adaptation of antileukaemic and supportive therapy. A part of the ANLL NS 03 programme for the individualised therapy of acute nonlymphoblastic leukaemia in patients no older than 60 years will be described. The programme is based on a network of prognostic models, identifying predictors and preventive measures against an unfavourable outcome. The crucial point of the ANLL NS 03 programme is to determine the optimal timing for the transplantation of allogeneic and autologous haematopoietic stem cells. Indicators of early death include the age of the patient, infection, and hemorrhagic syndrome. According to our models, the predictors of fatal bleeding and fatal infection are hyperleukocytosis, leucopenia, and granulocytopenia, respectively. Resistance to cytostatics can be predicted on day 14 from the onset of therapy using two original cytological-mathematical parameters: the absolute blast count (ABC) forming the intensity dimension, and parameter S forming the selectivity dimension, of the early effects of the first induction treatment. The ABC and S values determine the structure and timing of the second induction treatment. Transplantation of autologous and allogeneic haematopoietic stem cells within the ANLL NS 03 programme is applied selectively during the early stages of the first remission in patients at high risk of an early relapse. Predictors of early relapse are leukocyte counts higher than 30x10(9)/l, remission induction during the second treatment, and the presence of myelodysplasia. In all other patient categories and in patients with cytogenetically favourable forms of acute nonlymphoblastic leukaemia, transplantation is postponed until the second remission of the disease.