Figure 2 Schematic design of the PARMA study. Figure 3 Preliminary data from the PARMA study,
as presented at international meetings in 1992 and 1993. Figure 4 Overall survival of patients randomized to either high-dose therapy followed by transplantation or conventional therapy. ACUTE MYELOID LEUKEMIA (AML) Complete Remission Although it has been known for a long time that achieving a complete remission is the sine qua non for long-term survival, induction of remission has been fairly standardized over Inhibitors,research,lifescience,medical the past four decades. Standard induction for AML consists of 3 days of an anthracycline, usually TKI-258 solubility dmso daunorubicin, together with 7 days of cytarabine. The problem here relates to data
published in the late 1980s and the 1990s, which indicated that using virtually identical drug regimens the complete remission rate varied from 55% to 60% among the Southwest Oncology Group (SWOG) in the US, 65%–70% Inhibitors,research,lifescience,medical among the Eastern Cooperative Oncology Group (ECOG) in the US, 70%–75% in the Cancer and Leukemia Group B (CALGB) in the US, and 75%–85% in Medical Research Council (MRC) in Britain (Table 2). Despite these differences in the complete remission rate, the overall Inhibitors,research,lifescience,medical outcome for AML for younger adults is virtually identical in each of the major groups when evaluating for survival from diagnosis (Figure 5).7 The question still remained how these identical survival results could be achieved when there are such heterogeneous reports of the complete remission rates. Although not always clearly specified Inhibitors,research,lifescience,medical in the manuscripts, it was clear to practitioners that these discrepancies did not reflect an inherent difference in practice or responses within institutions. The explanation
here reflects a difference in the Inhibitors,research,lifescience,medical requirement or definition of a complete response such that, for example, in SWOG, patients needed to undergo central review at diagnosis and upon recovery of blood counts in order to confirm a complete remission. In ECOG, although central review was not required at the achievement of complete remission, final blood results needed to be performed at an ECOG-certified laboratory. This meant that Dichloromethane dehalogenase if a patient was discharged from the hospital, in apparent remission, but with a platelet count of 70,000/μL, and the confirmatory platelet count of over 100,000/μL required for the definition of complete remission was not performed at an ECOG-certified laboratory, such a patient could not be categorized as achieving complete remission (Table 3). Figure 5 Overall survival from diagnosis of patients younger than 60 years with acute myeloid leukemia. Table 2 AML—induction therapy—3 days of anthracycline and 7 days of cytarabine (“3+7”).