| چکیده انگلیسی مقاله |
Intensive induction therapy-in acute myeloid leukemia (AML), as in some other systemic malignancies- is a strategy fundamentally different from post-remission strategies. Approaches like consolidation treatment, prolonged maintenance, and autologous or allogeneic transplantation in the first remission are directed against minimal residual disease with a malignant cell population having survived the induction treatment. In contrast, induction therapy deals with naive tumor cells possibly different in their sensitivity from their counterparts in remission. Therefore, in AML it has been suggested to introduce intensification strategies into the induction part of treatment as a new step after the preceding intensification steps in the post-remission part. As expected from the dose effects observed in post-remission treatment using more AraC or longer treatment, similar dose effects have been found in the induction treatment both by the incorporation of high-dose AraC and by the double induction strategy administered in patients up to 60 years of age. For example, patients with poor risk AML due to an unfavorable karyotype, high LDH in serum, or delayed response, benefited from double induction containing high-dose AraC by a longer survival as compared to that from standard dose AraC. A corresponding dose effect in the induction treatment has been found in patients of 60 years and older receiving daunorubicin 60 vs 30 mg/m2 as part of the TAD regimen with higher dosage. This treatment significantly increased the response and survival rate in older patients who represented a poor risk group as a whole. Thus, we could demonstrate, both in younger and older patients, that a poor prognosis can be improved by a more intensive induction therapy. High-dose AraC in induction, however, exhibits a cumulative toxicity in that a repetition of courses containing high-dose AraC in the post-remission period is associated with considerable myelotoxicity leading to longlasting aplasias of about 6 weeks. However, after intensive induction treatment, high-dose chemotherapy in remission may become practicable using autologous stem cell rescue and may contribute to a further improvement of the outcome in poor risk as well as average patients with AML. These approaches are currently investigated by the German AMLCG. While there are clear limitations in the intensity of antineoplastic treatment for AML, as for other systemic malignancies, some further intensification may be possible and effective. |
| نویسندگان مقاله |
توماس büchner | thomas büchner
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
ولفگنگ hiddemann | wolfgang hiddemann
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
ولفگنگ e berdel | wolfgang e berdel
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
برنارد wörmann | bernhard wörmann
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
helmut löffler | helmut löffler
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
claudia schoch | claudia schoch
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
torsten haferlach | torsten haferlach
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
ولف جان لوودویک | wolf dieter ludwig
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
گیورگ maschmeyer | georg maschmeyer
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
ایوا lengelder | eva lengelder
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
پیتر staib | peter staib
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
راینارد andreesen | reinhard andreesen
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
leopold balleisen | leopold balleisen
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
detlef haase | detlef haase
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
hartmut eimermacher | hartmut eimermacher
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
آندرآ schumacher | andrea schumacher
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
carlo aul | carlo aul
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
هربرت rasche | herbert rasche
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
jens uhlig | jens uhlig
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
آندراس grüneisen | andreas grüneisen
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
هانس ادگار رییس | hans edgar reis
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
joachim hartlapp | joachim hartlapp
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
ولف dietrich hirschmann | wolf dietrich hirschmann
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
هانس josef weh | hans josef weh
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
hermann josef pielken | hermann josef pielken
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
winfried gassmann | winfried gassmann
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
ماریا cristina sauerland | maria cristina sauerland
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
achim heinecke | achim heinecke
dept. of medicine, hematology and oncology; university of münster, albert- schweitzer-str. 33, d-48129 münster; germany
|