Author/Editor		Modic, Mojca
Title		Naše iskušnje pri zdravljenju akutne nelimfoblastne levkemije odraslih s protokolom AML 10
Translated title		Our results in adult patients with acute myeloid leukemia treated according to AML 10 protocol
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 67, št. Suppl 1
Publication year		1998
Volume		str. I-35-8
Language		slo
Abstract		Background. Succesful treatment of acute myeloblastic leukemia (AML) in adulst requires intensive combination chemotherapy for induction of complete remission. The results of several collaborative trials for the treatment of AML indicate that complete remission can be achived in over 80% of patients under the age of 50.20-50% of patients were still alive at 3-5 years.. The AML 10 regiment was studied in our institute between 1994 and 1996. Methods. Between january 1994 and June 1996 20 adult patients with newly diagnosed acute myeloid leukemia were eligible for induction chemotherapy (AML 10 regiment). Mean age was 45 year, range 27-55 years. Induction chemotherapy uniformly consisted of citosin arabinoside, daunorubicin and thioguanin. Remission consolidation therapy consisted of amsacrine, etoposide, mitozantrone, cytosin arabinoside. The expression of myeloid surface markers at first diagnosis were studied. Cytogenetics investigation were performed on bone marrow in 18 of patients. Results and conclusion. 65% (13) of patients achived complete remission. The remission duration was 11 months (range 2-28). One patient underwent allogenic bone marrow transplantation (BMT). BMT was performed at a median of 7 months from diagnosis in first remission. 4 patients (20%) died within 6 weeks after start of chemotherapy. predominantly couses of mortality proved to be infection and haemorhage. Studies of the value of remission maintance chemotherapy in prolonging survival have given conflicting results with some studies showing benefit and others showing no benefit. The quality of life for patients receiving no further chemotherapy may be superior.
Summary		Izhodišča. Za uspešno zdravljenje akutne nelimfoblastne levkemije (ANLL) pri odraslih je potrebna intenzivna kombinacija več citostatikov. Z njimi dosežemo danes popolno remisijo bolezni v 80% bolnikov mlajših od 50 let in 3 do 5 letno preživeje v 20 do 50%. Hoteli smo oceniti zdravljenje ANLL pri odraslih po AML 10 protokou, ki ga od leta 1994 uporabljamo na Kliničnem oddelku za hemtologijo v Ljubljani. Material in metode. Od januarja 1994 do junija 1996 smo zdravili 20 odraslih bolnikov z ANLL po protokolu AML 10, povprečna starost bolnikov je bila 45 let, razpon 27-55 let. Za indukcijo remisije smo uporabili citostatike citozin arabinozid, daunorubicin in tioguanin, za konsolidacijo remisije pa amsakrin, etopozid, mitoksantron in citozin arabinozid. Pri 20 bolnikih smo blastnim celicam v kostnem mozgu določili celična imunološka znamenja. Pri 18 bolnikih smo določili kariogram iz kostnega mozga. Rezultati in zaključki. pri 13 bolnikih (65%) smo dosegli remisijo bolezni, ki je v povprečju trajala 11 mesecev (razpon 2 do 28 mesecev). Pri eni bolnici smo naredili alogenično presaditev kostnega mozga 7 mesecev od diagnoze bolezni v prvi remisiji. Štirje bolniki (20%) so umrli v prvih 6 tednih od začetka citostatskega zdravljenja. Najpogostejši vzroki smrti so bile okužbe in krvavitve. Protokol AML 10 zajema 4 intenzivne cikluse citostatikov, pri katerih vedno dosežemo oplazijo kostnega mozga. Vendar se zaradi intenzivnega konsolidacijskega zdravljenja izognemo dolgotrajnemu vzdrževalnemu citostatskemu zdravljenju. Menim, da se s tem kvaliteta življenja bolnika izboljša, ne glede na to,da bolniki prve mesece preživijo dalj časa v bolnišnici.
Descriptors		LEUKEMIA, NONLYMPHOCYTIC, ACUTE ANTINEOPLASTIC AGENTS, COMBINED ADULT TREATMENT OUTCOME