Complete Remission of Acute Myeloid Leukemia in Induction and Consolidation Chemotherapy without Bone Marrow Transplantation: Lessons Learned from Good Presentation Case

Tuti Sri Hastuti, Rachmat Sumantri, Indra Wijaya


Acute myeloid leukemia (AML) is a clinically morphologically and genetically heterogeneous disease with variable responses to therapy. The majority of the patients eventually relapse and succumb to the disease. Therapeutic modalities of induction chemotherapy, consolidation, and bone marrow transplantation are intended to achieve complete remission. Induction therapy with cytarabine and anthracycline remains thestandard of care in AML. Consolidation treatment is necessary to prevent recurrence, which may reach 90% without this treatment. Options for consolidation therapy are conventional chemotherapy and bone marrow transplantation. Bone marrow transplantation represents the only realistic chance of long-term remission in patients with a high cytogenetic risk. The risk of recurrence of AML is determined mainly by the patient’s age and genetic factors. In younger patients, complete remission (CR) rates of ≥80% may be achieved, with 5-year overall survival (OS) of 40%. InDr. Hasan Sadikin Hospital Bandung during the period of 2013-2018, 12 cases of LMA underwent chemotherapy. This case study discusses a young patient with AML who has successfully reached complete remission using induction and consolidation chemotherapy without bone marrow transplantation.   

Key words: Acute myeloid leukemia, chemotherapy, complete remission


Remisi Lengkap Pasca Kemoterapi Induksi dan Konsolidasi Tanpa Transplantasi Sumsum Tulang pada Leukemia Mieloblastik Akut

Leukemia mieloblastik akut adalah sekelompok penyakit yang memiliki gejala klinis, morfologi sel darah, kelainan genetik, dan respon terhadap terapi yang sangat bervariasi. Sebagian besar pasien leukemia mieloblastik akut (LMA) biasanya akan mengalami kekambuhan dalam perjalanan penyakitnya. Kejadian kekambuhan dalam 5 tahun sebesar 9% untuk kekambuhan di ekstramedulari dan 29% kekambuhan di sumsum tulang. Tujuan terapi pada LMA adalah mencapai remisi lengkap dan mencegah kekambuhan melalui modalitas kemoterapi dan transplantasi sumsum tulang. Transplantasi sumsum tulang diindikasikan pada pasien LMA dengan risiko sitogenetik yang tinggi. Tingkat remisi lengkap ≥80% dapat dicapai, terutama pada pasien yang lebih muda dengan kelangsungan hidup keseluruhan 5 tahun 40%. Di Rumah Sakit Hasan Sadikin Bandung, selama kurun waktu 2013-2018 didapatkan 12 kasus LMA yang menjalani kemoterapi. Pada artikel ini didiskusikan 1 pasien LMA usia muda yang berhasil mencapai remisi lengkap dengan kemoterapi induksi dan konsolidasi tanpa menjalani transplantasi sumsum tulang dengan terapi pendukung yang optimal selama pemberian kemoterapi.

Kata kunci : Leukemia mieloblastik akut, kemoterapi, remisi lengkap


Acute myeloid leukemia, chemotherapy, complete remission

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Barnett A, Wetzler M, Lowenberg B. Therapeutic advances in acute myeloid leukemia. J Clin Oncol. 2011;29:487–94.

Storey S, Fowler T, Bryant AL. Comorbidity, physical function and quality of life in older adults with AML. Curr Geriatr Rep. 2017; 6(4):247–54.

Larson R, Lowenberg B, Rosmarin AG. Induction therapy for acute myeloid leukemia in younger adults. 2019. [cited February 2019]. Available from:

Dombret H, Gardin C. An update of current treatments for adult acute myeoid leukemia. Blood. 2017;127(1):53–61.

Chen X, Xie H, Wood BL, Walter RB, Pagel JM, Becker PS, et al. Relation of clinical response and minimal residual disease and their prognostic impact on outcome in acute myeloblastic leukemia. J Clin Oncol. 2015;33(11):1258–64.

Muller LP, Tidow CM. The indications for allogeneic stem cell transplantation in myeloid malignancies. Dtsch Arztabl Int. 2015;112(15):262–70.

Thol F, Schlenk RF, Heuser M, Ganser A. How I treat refractory and early relapsed acute myeloid leukemia. Blood. 2015;126(3):319–24.

NCCN. Clinical Practice guidelines in oncology (NCCN Guidelines) acute myeloid leukemia version 2. Plymouth Meeting, Pennsylvania: NCCN; 2018.

Döhner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Büchner T, et al. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood. 2017;129(4):424–47.

Estey E, Othus M, Lee SJ, Appelbaum FR, Gale RP. New drug approvals in acute myeloid leukemia: what’s the best point?. Leukemia. 30(3):521–25.

Othus M, Wood B, Estey E, Petersdorf S, Appelbaum F, Erba H, et al. Effect of minimal residual disease (MRD) information on prediction of relapse and survival in adult acute myeloid leukemia (SWOG S0106). Leukemia 2016;30(10):2080–3.

Ommen HB. Monitoring minimal residual diseases in acute myeloid leukaemia: a review of the current evolving strategies. Ther Adv Hematol. 2016;7(1):3–16.

Grimwade D, Hills RK. Independent prognostic factors for AML outcome. Hematology Am Soc Hematol Educ Program. 2009:385–95.


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