[The curative treatment of adult acute nonlymphocytic leukemia]

Based on bone marrow findings and bone marrow stem cell kinetics and response to treatment, we have developed individualization of intensive induction and postremission chemotherapy for adult acute nonlymphocytic leukemia (ANLL). Thirty-four consecutive adults with ANLL were treated with an intensified induction regimen and a high dose sequential postremission therapy consisting of daunomycin, Ara-C, 6-MP and prednisolone (DCMP). The first course of remission induction was continued till achievement of a complete marrow aplasia which resulted in a decrease of leukocyte count less than 0.6-0.8 X 10(9)/L, a decrease of marrow nucleated cell count to less than 8 X 10(9)/L, and a decrease of marrow leukemic cell to less than 5%. Postremission therapy consisted of 4 courses of DCMP and a course of high-dose Ara-C. The first postremission course was initiated within 2-3 weeks subsequent to the last induction course. Twenty-eight of 34 patients (82.4%) achieved complete remission. The 4 year disease free survival rate was 64.4 +/- 14.0%. The results convinced us that individualized intensive induction and postremission therapy of adult ANLL given at the time of minimal residual leukemic disease in early remission might be sufficiently effective to produce long-term DFS to be considered potential cured.