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      KCI등재 SCI SCIE SCOPUS

      Oral Maintenance Chemotherapy with 6-Mercaptopurine and Methotrexate in Patients with Acute Myeloid Leukemia Ineligible for Transplantation

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      https://www.riss.kr/link?id=A104770431

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      다국어 초록 (Multilingual Abstract)

      For decades, maintenance chemotherapy has failed to improve the cure rate or prolong the survival of patients with acute myeloid leukemia (AML), other than those with acute promyelocytic leukemia. Immediately after the first complete remission following consolidation therapy was obtained, oral maintenance chemotherapy (daily 6-mercaptopurine and weekly methotrexate) was given and continued for two years in transplant-ineligible AML patients. Leukemia-free survival (LFS) and overall survival (OS) were studied and compared between these patients and the historical control group who did not receive maintenance therapy. Consecutive 52 transplant-ineligible AML patients were analyzed. Among these patients, 27 received oral maintenance chemotherapy. No significant difference was found in the patients’ characteristics between the maintenance and the control groups. The median OS was 43 (95% CI, 19-67) and 19 (95% CI, 8-30) months in the maintenance and the control groups, respectively (P = 0.202). In the multivariate analysis, the presence of maintenance therapy was an independent prognostic factor for better OS (P = 0.021) and LFS (P = 0.024). Clinical benefit from maintenance chemotherapy was remarkable in older patients (≥ 60 yr) (P = 0.035), those with intermediate or unfavorable cytogenetics (P = 0.006), those with initial low blast count in peripheral blood (P = 0.044), and those receiving less than two cycles of consolidation therapy (P = 0.017). Maintenance oral chemotherapy as a post-remission therapy can prolong the survival of patients with AML who are not eligible for transplantation, particularly older patients, those with intermediate or unfavorable cytogenetics, those with initial low blast count, and those receiving less than two cycles of consolidation therapy.
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      For decades, maintenance chemotherapy has failed to improve the cure rate or prolong the survival of patients with acute myeloid leukemia (AML), other than those with acute promyelocytic leukemia. Immediately after the first complete remission followi...

      For decades, maintenance chemotherapy has failed to improve the cure rate or prolong the survival of patients with acute myeloid leukemia (AML), other than those with acute promyelocytic leukemia. Immediately after the first complete remission following consolidation therapy was obtained, oral maintenance chemotherapy (daily 6-mercaptopurine and weekly methotrexate) was given and continued for two years in transplant-ineligible AML patients. Leukemia-free survival (LFS) and overall survival (OS) were studied and compared between these patients and the historical control group who did not receive maintenance therapy. Consecutive 52 transplant-ineligible AML patients were analyzed. Among these patients, 27 received oral maintenance chemotherapy. No significant difference was found in the patients’ characteristics between the maintenance and the control groups. The median OS was 43 (95% CI, 19-67) and 19 (95% CI, 8-30) months in the maintenance and the control groups, respectively (P = 0.202). In the multivariate analysis, the presence of maintenance therapy was an independent prognostic factor for better OS (P = 0.021) and LFS (P = 0.024). Clinical benefit from maintenance chemotherapy was remarkable in older patients (≥ 60 yr) (P = 0.035), those with intermediate or unfavorable cytogenetics (P = 0.006), those with initial low blast count in peripheral blood (P = 0.044), and those receiving less than two cycles of consolidation therapy (P = 0.017). Maintenance oral chemotherapy as a post-remission therapy can prolong the survival of patients with AML who are not eligible for transplantation, particularly older patients, those with intermediate or unfavorable cytogenetics, those with initial low blast count, and those receiving less than two cycles of consolidation therapy.

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      참고문헌 (Reference)

      1 Cassileth PA, "Varying intensity of postremission therapy in acute myeloid leukemia" 79 : 1924-1930, 1992

      2 Pui CH, "Treatment of acute lymphoblastic leukemia" 354 : 166-178, 2006

      3 Nagai S, "Risk-adapted maintenance therapy for acute promyelocytic leukemia" 28 : 21-, 2010

      4 Bennett JM, "Proposals for the classification of the acute leukaemias. French-American-British (FAB) co-operative group" 33 : 451-458, 1976

      5 Patel JP, "Prognostic relevance of integrated genetic profiling in acute myeloid leukemia" 366 : 1079-1089, 2012

      6 Karp JE, "Phase II trial of tipifarnib as maintenance therapy in first complete remission in adults with acute myelogenous leukemia and poor-risk features" 14 : 3077-3082, 2008

      7 Löwenberg B, "Mitoxantrone versus daunorubicin in induction-consolidation chemotherapy--the value of low-dose cytarabine for maintenance of remission, and an assessment of prognostic factors in acute myeloid leukemia in the elderly: final report. European Organization for the Research and Treatment of Cancer and the Dutch-Belgian Hemato-Oncology Cooperative Hovon Group" 16 : 872-881, 1998

      8 Krug U, "Maintenance therapy in acute myeloid leukemia revisited: will new agents rekindle an old interest?" 17 : 85-90, 2010

      9 Robles C, "Low-dose cytarabine maintenance therapy vs observation after remission induction in advanced acute myeloid leukemia : an Eastern Cooperative Oncology Group Trial(E5483)" 14 : 1349-1353, 2000

      10 Baer MR, "Is there a role for maintenance therapy in acute myeloid leukaemia?" 22 : 517-521, 2009

      1 Cassileth PA, "Varying intensity of postremission therapy in acute myeloid leukemia" 79 : 1924-1930, 1992

      2 Pui CH, "Treatment of acute lymphoblastic leukemia" 354 : 166-178, 2006

      3 Nagai S, "Risk-adapted maintenance therapy for acute promyelocytic leukemia" 28 : 21-, 2010

      4 Bennett JM, "Proposals for the classification of the acute leukaemias. French-American-British (FAB) co-operative group" 33 : 451-458, 1976

      5 Patel JP, "Prognostic relevance of integrated genetic profiling in acute myeloid leukemia" 366 : 1079-1089, 2012

      6 Karp JE, "Phase II trial of tipifarnib as maintenance therapy in first complete remission in adults with acute myelogenous leukemia and poor-risk features" 14 : 3077-3082, 2008

      7 Löwenberg B, "Mitoxantrone versus daunorubicin in induction-consolidation chemotherapy--the value of low-dose cytarabine for maintenance of remission, and an assessment of prognostic factors in acute myeloid leukemia in the elderly: final report. European Organization for the Research and Treatment of Cancer and the Dutch-Belgian Hemato-Oncology Cooperative Hovon Group" 16 : 872-881, 1998

      8 Krug U, "Maintenance therapy in acute myeloid leukemia revisited: will new agents rekindle an old interest?" 17 : 85-90, 2010

      9 Robles C, "Low-dose cytarabine maintenance therapy vs observation after remission induction in advanced acute myeloid leukemia : an Eastern Cooperative Oncology Group Trial(E5483)" 14 : 1349-1353, 2000

      10 Baer MR, "Is there a role for maintenance therapy in acute myeloid leukaemia?" 22 : 517-521, 2009

      11 Büchner T, "Intensified induction and consolidation with or without maintenance chemotherapy for acute myeloid leukemia(AML) : two multicenter studies of the German AML Cooperative Group" 3 : 1583-1589, 1985

      12 British Committee for Standards in Haematology, "Guidelines on the management of acute myeloid leukaemia in adults" 135 : 450-474, 2006

      13 Clift RA, "Follow-up 26 years after treatment for acute myelogenous leukemia" 351 : 2456-2457, 2004

      14 Büchner T, "Double induction containing either two courses or one course of high-dose cytarabine plus mitoxantrone and postremission therapy by either autologous stem-cell transplantation or by prolonged maintenance for acute myeloid leukemia" 24 : 2480-2489, 2006

      15 Burnett AK, "Curability of patients with acute myeloid leukemia who did not undergo transplantation in first remission" 31 : 1293-1301, 2013

      16 Preisler H, "Comparison of three remission induction regimens and two postinduction strategies for the treatment of acute nonlymphocytic leukemia : a cancer and leukemia group B study" 69 : 1441-1449, 1987

      17 Mrózek K, "Clinical relevance of mutations and gene-expression changes in adult acute myeloid leukemia with normal cytogenetics: are we ready for a prognostically prioritized molecular classification?" 109 : 431-448, 2007

      18 이현규, "Clinical characteristics and treatment outcome of acute myeloid leukemia in elderly patients in Korea: a retrospective analysis" 대한혈액학회 49 (49): 95-99, 2014

      19 Cassileth PA, "Chemotherapy compared with autologous or allogeneic bone marrow transplantation in the management of acute myeloid leukemia in first remission" 339 : 1649-1656, 1998

      20 Deschler B, "Acute myeloid leukemia : epidemiology and etiology" 107 : 2099-2107, 2006

      21 Estey EH, "Acute myeloid leukemia : 2014 update on risk-stratification and management" 89 : 1063-1081, 2014

      22 Löwenberg B, "Acute myeloid leukemia" 341 : 1051-1062, 1999

      23 Sauter C, "Acute myelogenous leukaemia : maintenance chemotherapy after early consolidation treatment does not prolong survival" 1 : 379-382, 1984

      24 Avvisati G, "AIDA 0493 protocol for newly diagnosed acute promyelocytic leukemia : very long-term results and role of maintenance" 117 : 4716-4725, 2011

      25 Miyawaki S, "A randomized, postremission comparison of four courses of standard-dose consolidation therapy without maintenance therapy versus three courses of standard-dose consolidation with maintenance therapy in adults with acute myeloid leukemia: the Japan Adult Leukemia Study Group AML 97 Study" 104 : 2726-2734, 2005

      26 Asou N, "A randomized study with or without intensified maintenance chemotherapy in patients with acute promyelocytic leukemia who have become negative for PML-RARalpha transcript after consolidation therapy : the Japan Adult Leukemia Study Group(JALSG)APL97 study" 110 : 59-66, 2007

      27 Fenaux P, "A randomized comparison of all transretinoic acid (ATRA) followed by chemotherapy and ATRA plus chemotherapy and the role of maintenance therapy in newly diagnosed acute promyelocytic leukemia. The European APL Group" 94 : 1192-1200, 1999

      28 Büchner T, "6-Thioguanine, cytarabine, and daunorubicin (TAD) and high-dose cytarabine and mitoxantrone (HAM) for induction, TAD for consolidation, and either prolonged maintenance by reduced monthly TAD or TAD-HAM-TAD and one course of intensive consolidation by sequential HAM in adult patients at all ages with de novo acute myeloid leukemia (AML): a randomized trial of the German AML Cooperative Group" 21 : 4496-4504, 2003

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      학술지 이력

      학술지 이력
      연월일 이력구분 이력상세 등재구분
      2023 평가예정 해외DB학술지평가 신청대상 (해외등재 학술지 평가)
      2020-01-01 평가 등재학술지 유지 (해외등재 학술지 평가) KCI등재
      2011-01-01 평가 등재학술지 유지 (등재유지) KCI등재
      2009-01-01 평가 등재학술지 유지 (등재유지) KCI등재
      2005-01-01 평가 SCI 등재 (등재유지) KCI등재
      2002-01-01 평가 등재학술지 선정 (등재후보2차) KCI등재
      1999-07-01 평가 등재후보학술지 선정 (신규평가) KCI등재후보
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      기준연도 WOS-KCI 통합IF(2년) KCIF(2년) KCIF(3년)
      2016 1.48 0.37 1.06
      KCIF(4년) KCIF(5년) 중심성지수(3년) 즉시성지수
      0.85 0.75 0.691 0.11
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