[Recent progress in the treatment of acute leukemia]

Acute leukemia has become a curable disease. In 3 studies for adult AML (BHAC-DMP, BHAC-DMP (II) and M-85) at Nagoya University Hospitals from 1979 to 1987, intensive induction resulted in higher cure rate, and the reduction of the blasts in bone marrow at 2 weeks after the initiation of therapy to less than 20% was the most important prognostic factor to predict the long CR. However, it seemed impractical to give very intensive chemotherapy during the induction because of high frequency of complications due to prolonged myelosuppression. Thus, consolidation should be as intensive as possible. In M-85 protocol, the predicted 5-years survival and disease-free survival (DFS) of CR cases are 70 and 53% respectively. The result of JALSG-AML 87 study seems to confirm the above result. As for the indication of bone marrow transplantation (BMT) at the first CR for adult AML, only a prospective randomized study will answer this important question. In case that DFS of chemotherapy will exceed 40 to 45%, it seems be wise to give chemotherapy first, and then BMT when the leukemia relapse. Differentiation induction therapy seems to be indicated in acute promyelocytic leukemia, although a confirmative study is awaited.