Ten-year complete remission in an 84 year-old patient with acute myeloid leukemia

We report an unusual case in which complete remission of acute myeloid leukemia (AML) had lasted for almost 10 years in a patient who was 94 years and 7 months old as of September 1989. An 84 year-old man was admitted to our hospital with gingival bleeding on October 15, 1979. Hematological data were: RBC 327 x 10(4) microliters, hemoglobin concentration 10 g/dl, platelets 3.8 x 10(4) microliters and WBC 9000 microliters, including 34% blastic cells. Bone marrow aspiration showed nucleated cells 48.0 x 10(4)/microliters with 69.2% blastic cells. He was diagnosed as having AML (M2). Induction chemotherapy consisted of daunorubicin, cyclocytidine, an anhydride analogue of cytosine arabinoside, and prednisolone (DCP). Complete remission was achieved after 1 month of this therapy. After two cycles of consolidation therapy (DCP), intensification therapy (DCP) was performed twice. Thereafter, complete remission lasted without any further therapy, up to September 1989, when he died of pancreatic cancer. The prolonged disease-free survival in this extremely aged patient was attributed to the high sensitivity of leukemic cells to DCP therapy and his good performance status at the time of initial induction chemotherapy. This is the oldest patient with long-term remission, lasting for over 5 years, to be reported in Japan. If an elderly patient with typical acute leukemia has a good performance status, intensive chemotherapy should be tried at least once, while carefully controlling complications specific to the elderly.