Intensified induction and consolidation with or without maintenance chemotherapy for acute myeloid leukemia (AML): two multicenter studies of the German AML Cooperative Group.

In two multicenter trials, a total of 576 patients with acute myeloid leukemia (AML) were treated and found to be evaluable. Two hundred forty-two patients were in a 1978 pilot study and 334 patients were in a 1982 randomized study. Ages were between 15 and 78 years (median, 48). The uniform remission induction therapy in both studies consisted of one to two courses of a 9-day combination of 6-thioguanine (TG) with cytosine arabinoside (ARA-C) and daunorubicin (DNR) [TAD9]. The timing and sequencing of TAD9 was designed according to cell kinetic effects of ARA-C. A complete remission (CR) was achieved in 65% (70% and 61%, respectively) of patients within a median of 33 days, and in 68% of responders after only one course. The CR rate in patients 60 to 78 years of age was 51% (66% and 39%, respectively). In the 1978 pilot study, different protocols of post-remission treatment were applied at the different centers: monthly 5-day maintenance, TAD9 consolidation, both consolidation and maintenance, or no further therapy. The group receiving treatment during CR showed 24% probability of remissions at 4 years v 0% probability of remissions in the untreated group. Between the different post-remission protocols, no significant differences were observed. Remission duration was not influenced by age, WBC, or morphologic cell type, but was longer in patients achieving CR within 30 days (P = .017). In the subsequent 1982 study, 145 patients in CR were randomized for TAD9 consolidation with or without monthly maintenance. The updated life-table analysis revealed a predicted rate of continuous remission at 2 1/2 years of 30% for the maintenance and 17% for the nonmaintenance arm (P = .003). These results of response and remission duration in adult patients of all ages support the validity of intensified induction therapy and of consequent myelosuppressive treatment in remission.

[Vinblastine, 5-fluorouracil and prednisone (VFP) as "second-line" chemotherapy. Contribution to the problem of optimal therapy sequence in metastasizing breast carcinoma]. / Vinblastin, 5-Fluorouracil und Prednison (VFP) als "second-line"-Chemotherapie. Ein Beitrag zum Problem der optimalen Therapiesequenz beim metastasierten Mammakarzinom.

Chemotherapy results in metastatic breast cancer reached a plateau: Remission rate and duration are nearly equivalent for several regimens but not equitoxic. We analyzed the effect of vinblastine (6 mg/m2 once a week i.v.), 5-fluorouracil (600 mg/m2 once a week i.v.) and prednisone (10-20 mg daily p.o.) as second line treatment in BC resistant to one of the other established regimens with regard to prognostic factors and pretreatment. Our results show that it is possible to produce more than one or even two remissions by consecutively applicated combinations of cytostatics with increasing aggressivity.

[Primary bilateral, adrenal, highly malignant B-cell lymphoma with lymphoblastic mengiosis]. / Primär beidseitiges, adrenales, hochmalignes B-Zell-Lymphom mit Meningiosis lymphoblastica.

A 64-year-old man with high malignant B-cell lymphoma in both adrenal glands was investigated. Adrenal insufficiency was his predominant symptom at presentation. Despite surgical resection of the malignancy and cytostatic chemotherapy leptomeningeal involvement occurred and the patient died nine month after the diagnosis. Nine so far reported cases with primary adrenal lymphoma were reviewed. One of these also developed lymphomatous leptomeningitis. Suggestions of a pathogenetic contribution of adrenal lymphoma to leptomeningeal involvement and arising therapeutic consequences in the treatment of primary adrenal lymphoma are discussed.

[The Bonn Cooperative Tumor Aftercare Model. A contribution to the amelioration of tumor patient care in the practitioner's office (author's transl)]. / Kooperatives Tumornachsorgemodell Bonn. Ein Beitrag zur verbesserten Betreuung von Tumorpatienten in der Praxis des Hausarztes.

Problems of aftercare of tumor patients are so involved that one doctor cannot cope with them single-handed. Every doctor who has care of tumor patients is dependent on the cooperation of doctors of various faculties as with scarcely any other disease. The experience of a specialized multidisciplinary medical team is as indispensable in aftercare as the general medical supervision of the family doctor. In an action financed by the Federal Minister of Health a cooperative model was worked out intended to enable a qualitatively high level of aftercare for tumor patients over a wide field, making full use of the existing medical welfare structure.