Korean J Hematol.  2004 Sep;39(3):127-133.

An Improved Outlook for Patients with Acute Leukemia over the Last 14 Years: A Perspective from a University Hospital

• Lee KH
• Choi SJ
• Lee JH
• Lee CH
• Seol M
• Lee YS
• Lee JS
• Kim WK
• Lee JH

Abstract

BACKGROUND
To see whether there has been improvement in the survival of patients with acute leukemia over the last 14 years, a retrospective analysis was performed.
METHODS
Clinical and laboratory data were obtained form the medical records. Patient survival data was obtained from the hospital records, national cancer registry or by direct phone contacts.
RESULTS
Between June, 1989 and August 2002, 714 adult patients were diagnosed with acute leukemia at Asan Medical Center in Seoul. Fourteen patients were lost to follow-up within 100 days of the diagnosis and excluded. There were 535 patients with acute myelogenous leukemia (AML) and 165 with acute lymphoblastic leukemia (ALL). There were 65 patients with acute promyelocytic leukemia (APL) among 535 patients with AML. Patients with non-APL AML and ALL were divided into 3 cohorts according to the year of the diagnosis: cohort I, 1989~1994; cohort II, 1995~1998; cohort III, 1999~2002. Patients with APL were also divided into 3 cohorts: cohort I, pre-all-transretinoic acid (ATRA) period (1989~1994. 2); cohort II, ATRA with or without chemotherapy (1994. 3~2000. 8); and cohort III, ATRA plus idarubicin (2000. 9~2002). Univariate analysis showed significant improvement in patient survival in non-APL AML (4-year projected survival rates of 10%, 19%, and 33% for cohorts I, II, and III, respectively, P=0.0000), in ALL (27%, 28%, and 52%, P=0.03), and in APL (36%, 56%, and 80%, P=0.04). Multivariate analysis showed that the year of diagnosis was a significant independent variable for patient survival in non-APL AML and ALL.
CONCLUSION
Our study showed significant survival improvement in acute leukemia over the last 14 years. This improvement is not likely due to change in patient demographics. Rather, it is likely that introduction of newer methods of treatment of acute leukemia, such as multi-cycle combination chemotherapy for ALL, high dose cytarabine consolidation for AML, ATRA for APL, and wider application of allogeneic hematopoietic cell transplantation, has resulted in a better patient survival.

Keyword

Acute leukemia; Patient survival

MeSH Terms

Adult
Cell Transplantation
Chungcheongnam-do
Cohort Studies
Cytarabine
Demography
Diagnosis
Drug Therapy
Drug Therapy, Combination
Hospital Records
Humans
Idarubicin
Leukemia*
Leukemia, Myeloid, Acute
Leukemia, Promyelocytic, Acute
Lost to Follow-Up
Medical Records
Multivariate Analysis
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Retrospective Studies
Seoul
Survival Rate
Transplants
Cytarabine
Idarubicin