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The article highlights the long-term results of two large, randomized trials on managing acute myeloid leukemia (AML) conducted by investigators from the Eastern Cooperative Oncology Group (ECOG) in the U.S. and a collaborative group of European investigators from the Netherlands, Belgium, Germany and Switzerland. Among the factors that negatively influence the outcome of patients with AML are older age, poor performance status and high white-cell count. Both studies have concluded that the 90-milligram (mg) dose of daunorubicin, as compared with the standard 45-mg dose, appear to be similar. According to the authors, high-dose daunorubicin does not benefit the majority of older patients with AML.

Acute promyelocytic leukemia (APL) is highly curable with the combination of all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy (CT), but very long-term results of this treatment, when CT should be added to ATRA and the role of maintenance treatment, remain uncertain. In our APL93 trial that included 576 newly diagnosed APL patients, with a median follow-up of 10 years, 10-year survival was 77%. Maintenance treatment significantly reduced 10-year cumulative incidence of relapses, from 43.2% to 33%, 23.4%, and 13.4% with no maintenance, maintenance using intermittent ATRA, continuous 6 mercaptopurine plus methotrexate, and both treatments, respectively (P < .001). Maintenance particularly benefited patients with white blood cell (WBC) count higher than 5 x 10(9)/L (5000/microL). Early addition of CT to ATRA significantly improved 10-year event-free survival (EFS), but without significant effect on overall survival (OS). The 10-year cumulative incidence of deaths in complete response (CR), resulting mainly from myelosuppression, was 5.7%, 15.4%, and 21.7% in patients younger than 55, 55 to 65, and older than 65 years, respectively, supporting the need for less myelosuppressive treatments, particularly for consolidation therapy. This study is registered at http://clinicaltrials.gov as NCT00599937.