Re-induction of complete remissions in adults with acute non-lymphocytic leukemia

Thirty-five adults with acute non-lymphocytic leukemia in relapse following an initial remission were treated with intensive combination chemotherapy. Each patient received one of three re-induction programs which had already proven effective in the treatment of newly-diagnosed patients. Twenty (57%) of the patients undergoing re-induction therapy achieved complete remission. Clinical features which predicted a favorable response to therapy were female gender, rapid achievement of first remission, absence of infection, low plasma fibrinogen and serum LDH levels, and normal hepatic enzymes. Patients were more likely to respond if they also received at least one chemotherapeutic agent during re-induction to which they had not been previously exposed. The median duration of complete remission was 4.4 months (range 1-94+ months). Second remissions lasted over one year in four patients and two patients currently remain in complete remission at 49 and 94 months. Median survival for all patients who achieved remission was 10 months compared to only 2.5 months for those failing therapy. Since the re-induction of complete remission prolongs survival and can be accomplished in the majority of patients with leukemia in relapse, consideration should be given to using established intensive treatment programs prior to experimental chemotherapy in adults with advanced leukemia.