Postremission therapy

Remission is not synonymous with cure. Following remission induction further treatment is required since disease free survival (DFS) for patients who do not receive additional therapy is only 4-8 months. The aim of postremission therapy is to prevent relapse with maximal efficiency and minimal toxicity (1).

Therapeutic options include:

• repeated intensive conventional chemotherapy
• Cancer and Leukaemia Group B (CALGB) have compared high dose of cytarabine (3 g/m2) with 400 mg/m2 and 100 mg/m2 doses and found out that in patients less than 60 years old, the 4 year DFS was higher in the high-dose cytarabine arm than the lower dose group (44% when compared with 29% and 24%)
• treatment-related mortality and significant neurotoxicity was reported in about 5% of patients older than 40 years with this treatment
• although similar outcomes can be observed with the use of other intense chemotherapy regimens, prolonged intensive consolidation or of multiagent chemotherapy does not appear to be superior to cytarabine alone
• high-dose chemoradiotherapy with allogeneic bone marrow transplantation
• high-dose chemotherapy with autologous bone marrow transplantation (2)

Reference:

• (1) British Committee for Standards in Haematology et al.Guidelines on the management of acute myeloid leukaemia in adults. Br J Haematol. 2006;135(4):450-74.
• (2) Döhner H et al. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 2010;115(3):453-74.