Acute leukemias : prognostic factors and treatment strategies

The progress in the treatment of childhood and adult acute leukemias within the last 10-15 years was pioneered by the work of single institl:tions incorporating modern leukemia cell research and pharmacology into the design of chemotherapeutic regimens. These new approaches, however, had to be validated by representative prospective studies in order to clearly demonstrate the efficacy of special concepts and to identify prognostic determinants and differences between patient subgroups. It was therefore the aim of the First International Symposium "Acute Leukemias: Prognostic Factors and Treatment Strategies" held in Munster in 1986 to provide a broad overview over the present status of chemotherapy and bone marrow transplantation in childhood and adult leukemias with special emphasis on the results of multicenter trials recruiting large numbers of patients in Europe and oversea countries. In addition, new aspects of cytogenetics, leukemia cell biology and modern diagnostic techniques as well as improvements in supportive treatment were covered. In an attempt to summarize the major results presented during this meeting, which are given in detail in the present book, the following conclusions may be drawn: In adults with acute myeloid leukemia complete remissions are achieved in 60 to 70% of all patients and translate into long­ term remissions in 15 to 25% of responders. Monthly maintenance chemotherapy was found to prolong remission duration significantly. In addition, late intensification, early consolidation or, as a new approach. Front Matter....Pages I-XXVI Front Matter....Pages 1-1 Cell Kinetics in Leukemia and Preleukemia....Pages 3-9 Acute Nonlymphocytic Leukemia in Adults: Pathophysiology, Status of Current Therapy, and New Approaches....Pages 10-14 Prognostic Significance of Chromosome Changes in Acute Leukemia....Pages 15-20 Morphological and Cytochemical Classification of Adult Acute Leukemias in Two Multicenter Studies in the Federal Republic of Germany....Pages 21-27 Front Matter....Pages 29-29 Therapeutic Strategies in Acute Myelocytic Leukemia: A Status Report of the Experience of CALGB....Pages 31-34 The Ninth British Medical Research Council Trial for the Treatment of Acute Myeloid Leukaemia....Pages 35-37 Long-Term Results of Two Swiss AML Studies....Pages 38-44 Prediction of Induction and Duration of Complete Remission in Acute Myelogenous Leukemia: Value of Clonogenic Cell Properties....Pages 45-49 Remission Induction and Maintenance Modalities in Acute Myeloid Leukemia: A Multicenter Randomized Study....Pages 50-56 Postinduction and Preremission Chemotherapy Alternatives for Adult AML: Three Multicenter Studies of the AML Cooperative Group....Pages 57-63 Neuraminidase-Treated Allogeneic Blasts for Maintenance in Acute Myelogenous Leukemia: Results of a Prospective Randomized Trial....Pages 64-68 Front Matter....Pages 69-69 The Childhood AML Studies BFM-78 and -83: Treatment Results and Risk Factor Analysis....Pages 71-75 Improved Treatment Results in Childhood Acute Nonlymphoblastic Leukemia with the BFM-AML Protocol 78 in a Multicenter Study in the GDR....Pages 76-82 A Comparison of Cytokinetically Based Versus Intensive Chemotherapy for Childhood Acute Myelogenous Leukemia....Pages 83-87 Postremission Induction Intensive Sequential Chemotherapy for Children with AML — Treatment Results and Prognostic Factors....Pages 88-92 Front Matter....Pages 93-93 Clinical Relevance of Blast Cell Phenotype as Determined with Monoclonal Antibodies in Acute Lymphoblastic Leukemia of Adults....Pages 95-103 Risk Groups in Adult Acute Lymphoblastic Leukemia....Pages 104-110 Prognostic Factors in Acute Lymphoblastic Leukemia in Adults: The Memorial Hospital Experience....Pages 111-124 Treatment of Adult Acute Lymphoblastic Leukemia. Preliminary Results of a Trial from the French Group....Pages 125-129 Therapy for Adolescent and Adult Acute Lymphoblastic Leukemia: Randomization of Induction and Consolidation Therapies (Preliminary Results of EORTC Study 58791)....Pages 130-136 Front Matter....Pages 137-137 Therapy Results in Five ALL-BFM Studies Since 1970: Implications of Risk Factors for Prognosis....Pages 139-146 The BFM Relapse Studies in Childhood ALL: Concepts of Two Multicenter Trials and Results after 21/2 Years....Pages 147-155 Limiting Toxicities During Intensified Remission Induction Chemotherapy for Childhood Acute Lymphocytic Leukemia....Pages 156-160 Stratification by Prognostic Factors in the Design and Analysis of Clinical Trials for Acute Lymphoblastic Leukemia....Pages 161-166 Strategies for the Treatment of Children with Acute Lymphoblastic Leukemia and Unfavorable Presenting Features....Pages 167-172 Front Matter....Pages 173-173 Infection Prevention and Immediate Antibiotic Therapy in the Neutropenic Patient....Pages 175-181 Special Aspects of Supportive Therapy in Childhood Acute Leukemias....Pages 182-187 Prevention of Infection in Patients with Acute Nonlymphocytic Leukemia by Several Drug Treatment Regimens....Pages 188-193 Front Matter....Pages 195-195 The Role of Bone Marrow Transplantation in Acute Myelogenous Leukemia....Pages 197-203 Allogeneic Marrow Transplantation for Treatment of Leukemia: Results of the Munich Cooperative Group....Pages 204-212 Bone Marrow Transplantation in Acute Leukemia....Pages 213-216 Bone Marrow Transplantation in Childhood Leukemia in West Germany....Pages 217-225 Allogeneic, Syngeneic, and Autologous Bone Marrow Transplantation in the Acute Leukemias — Baltimore Experience....Pages 226-232 Treatment of Patients with Acute Myeloid Leukemia in First Remission with Marrow Ablative Therapy and Autologous Bone Marrow Transplantation....Pages 233-236 Front Matter....Pages 237-237 Modification of tRNA and Its Applicability for the Assessment of Prognosis, State of Differentiation, and Clonality in Human Leukemias and Lymphomas....Pages 241-250 Immunoglobulin and T Cell Receptor Gene Rearrangements in Acute Leukemias....Pages 251-255 Abnormal Production and Release of Ferritin by Immature Myeloid Cells in Leukemia....Pages 256-260 Induction of Early Myeloperoxidase in Acute Unclassified Leukemia....Pages 261-264 Abnormal Marker Expression in Acute Leukemia (AL) Characterized by Monoclonal Antibodies and Flow Cytometry....Pages 265-270 Urinary GP41 Excretion in Patients with Acute Leukemias Treated with Intensive Induction Polychemotherapy....Pages 271-277 Front Matter....Pages 237-237 Toxicity and Mutagenicity of 6 Anti-Cancer Drugs in Chinese Hamster Cells Co-Cultured with Rat Hepatocytes....Pages 278-282 Pharmacokinetics of Daunorubicin as a Determinant of Response in Acute Myeloid Leukemia....Pages 283-287 Pharmacokinetic Study of Cytosine Arabinoside in Patients with Acute Myelogeneous Leukemia....Pages 288-292 Pharmacokinetics of Oral Methotrexate in Bone Marrow During Maintenance Treatment of Childhood Acute Lymphocytic Leukemia....Pages 293-297 Determination of the Cellular Uptake of Daunorubicin in Human Leukemia in vivo: Method of Examination and First Results....Pages 298-301 Cytoskeletal Organization in Acute Leukemias....Pages 302-307 Pitfalls in the Evaluation of Prognostic Factors....Pages 308-312 Low-Dose Ara-C in Myelodysplastic Syndromes and Acute Nonlymphoid Leukemia. Experience with Seven Patients....Pages 315-321 Low-Dose Cytosine Arabinoside in Patients with Acute Myeloblastic Leukemia and Myelodysplastic Syndrome....Pages 322-325 Low-Dose Ara-C Treatment in Elderly Patients with Acute Myeloblastic Leukemia....Pages 326-329 Acute Leukaemia in the Elderly, Remission Induction Versus Palliative Therapy....Pages 330-332 The Use of Amsacrine plus Intermediate-Dose Cytosine Arabinoside in Relapsed and Refractory Acute Nonlymphocytic Leukemia....Pages 333-335 Phase I/II Trial of High-Dose Cytosine Arabinoside and Mitoxantrone in Adult Refractory Acute Myeloid Leukemia....Pages 336-338 Mitoxantrone and VP-16 in Refractory Acute Myelogenous Leukemia....Pages 339-342 4-Demethoxydaunorubicin (Idarubicin) in Relapsed and Refractory Acute Myeloid Leukemia....Pages 343-345 Intensive Induction and Consolidation Chemotherapy for Adults and Children with Acute Myeloid Leukaemia (AML) Joint AML Trial 1982–1985....Pages 346-351 Remission Induction with Cytarabine and Daunorubicin With or Without 6-Thioguanine in Adult Patients With Acute Myelocytic Leukemia....Pages 352-355 Contribution of Clonogenic Leukemic Cell Characteristics to Therapy Outcome in Patients With Acute Myeloblastic Leukemia....Pages 356-360 Expression of CD-15 Antigen on Leukemic Cells — A New Prognostic Factor for Ability to Achieve Complete Remission and for Survival in ANLL....Pages 361-364 Prognostic Significance of Morphologic and Cytogenetic Findings for Progression in Myelodysplastic Syndromes....Pages 365-368 Front Matter....Pages 237-237 Analysis of Prognostic Factors in Acute Leukemias in Adults....Pages 369-372 Acute Myelocytic Leukemia in Adults: A Long-Term Analysis....Pages 373-375 Prognostic Factors in Acute Myelogenous Leukemia....Pages 376-379 Serum Zinc and Copper as Prognostic Factors in Acute Nonlymphocytic Leukemia....Pages 380-384 Immunological Monitoring in Remission Acute Myeloid Leukemia During Maintenance Therapy....Pages 385-386 Treatment of Childhood Acute Nonlymphocytic Leukemia with Individually Scheduled High Doses of Cytarabine: Preliminary Results of Study ANLL-82 of the Dutch Childhood Leukemia Study Group (DCLSG)....Pages 389-392 Aclacinomycin-A in the Induction Treatment of Childhood Acute Myelogenous Leukemia....Pages 393-398 High-Dose Cytosine Arabinoside and Retinol in the Treatment of Acute Myelogenous Leukemia in Childhood....Pages 399-402 CHOP Treatment of Childhood Acute Myelogenous Leukemia with Monocytic Differentiation: A Report on Five Cases....Pages 403-405 Effective Remission Induction in Children with Recurrent Acute Myeloid Leukemia by mAMSA, Ara-C, and VP 16....Pages 406-409 Alteration of Blast Phenotype after Low-Dose Cytarabine in Children with Acute Myeloid Leukemia....Pages 410-412 Biphenotypic Leukemia in Childhood: Presentation of Five Cases....Pages 413-417 Surface Marker Analysis by Monoclonal Antibodies: A Valuable Technique in Childhood Acute Myeloid Leukemia....Pages 418-422 Infant Leukemia: A Single Pattern of Nonlymphocytic Leukemia?....Pages 423-423 Growth of Children with Acute Lymphocytic Leukemia: Preliminary Results....Pages 427-431 Two Unexpected Courses in Four Children with Lymphoblastic Leukemia of B-Cell Type (B-ALL)....Pages 432-436 Progress in Treatment of Children with non-Hodgkin Lymphoma: A Report of the Polish Leukemia and Lymphoma Study Group....Pages 437-443 Addition of Rubidomycin to Induction Treatment with Vincristine, Prednisone, and l -Asparaginase in Standard-Risk Childhood Acute Lymphocytic Leukemia (Study ALL V): A Report on Behalf of the Dutch Childhood Leukemia Study Group....Pages 444-447 Medical Research Council Childhood Leukaemia Trial VIII Compared with Trials II–VII: Lessons for Future Management....Pages 448-455 Early Intensification Therapy in High-Risk Childhood Acute Lymphocytic Leukemia: Lack of Benefit from High-Dose Methotrexate....Pages 456-460 Front Matter....Pages 237-237 Intermediate-Risk Childhood Acute Lymphoblastic Leukemias: Amsacrine + Cytosine Arabinoside Versus Intermediate-Dose Methotrexate for Consolidation, and 6-Mercaptopurine + Methotrexate + Vincristine Versus Monthly Pulses for Maintenance....Pages 461-465 Treatment of Acute Lymphoblastic Leukemia in Children with the BFM Protocol: A Cooperative Study and Analysis of Prognostic Factors....Pages 466-470 Results of Acute Lymphoblastic Leukemia Therapy in Childhood with a Modified BFM Protocol in a Multicenter Study in the German Democratic Republic....Pages 471-479 Intensive Therapy in Childhood Acute Lymphoblastic Leukemia: A Report from the Polish Children’s Leukemia and Lymphoma Study Group After 11 Years....Pages 480-482 Treatment of Standard- and High-Risk Childhood Acute Lymphoblastic Leukaemia with Two CNS Prophylaxis Regimens....Pages 483-492 Aggressive Combination Chemotherapy of Bone Marrow Relapse in Childhood Acute Lymphoblastic Leukemia Containing Aclacinomycin-A: A Multicentric Trial....Pages 493-496 Prognostic Meaning of Chromosome Aberrations in Acute Lymphocytic Leukemia and Acute Nonlymphocytic Leukemia Patients of the BFM Study Group....Pages 497-503 Karyotype, Immunophenotype, and Clinical Outcome: Correlations in Childhood Acute Lymphoblastic Leukemia....Pages 504-508 DNA Aneuploidy in Children with Relapsed Acute Lymhoblastic Leukemia as Measured by Flow Cytometry....Pages 509-512 Hyperdiploid Childhood Acute Lymphocytic Leukemia: Cellular Properties and Prognostic Implications....Pages 513-516 Intensive Care Therapy for Patients with Hematological Diseases....Pages 519-523 The Problem of Early Death in Childhood AML....Pages 524-529 Passive and Active Anti-Hepatitis B Immunization of Children with Hematological Malignancies....Pages 530-534 Increased Awareness of Aspergillosis in Acute Leukemia Patients....Pages 535-537 Cytomegalovirus Hyperimmunoglobulin and Substitution with Blood Products from Antibody-Negative Donors. A Pilot Study in Bone Marrow Transplant Recipients....Pages 538-540 Prophylactic Application of an Anti-Cytomegalovirus Hyperimmunoglobulin in Allogeneic Bone Marrow Transplant Recipients....Pages 541-544 Incidence and Treatment of Fungal Infections in Neutropenic Patients....Pages 545-546 First Experiences with a Permanent Catheter System in Acute Leukemia....Pages 547-550 On the Fate of Leukemic Cells Infused with the Autologous Marrow Graft....Pages 553-559 Hematological Reconstitution After Autologous Peripheral Blood Transplantation....Pages 560-562 Front Matter....Pages 237-237 Depletion of T Cells from Bone Marrow Grafts with Soybean Agglutinin and Sheep Red Blood Cells for Prevention of Graft-Versus-Host Disease....Pages 563-566 Bone Marrow Transplantation for Chronic Granulocytic Leukemia: Results of the French Cooperative Group (GEGMO)....Pages 567-570 An HLA Lost Mutation May Lead to Leukemic Relapse of Recipient Type Six Years After Bone Marrow Transplantation....Pages 571-573 Toxoplasmosis After Bone Marrow Transplantation....Pages 574-578 Back Matter....Pages 579-586