consolidation therapy

Consolidation therapies, which are less applicable for the very elderly.

In general, all remissions will fail without additional consolidation therapy.

If no further postremission or consolidation therapy is given, almost all patients will eventually relapse.

Patients at high risk of relapse may benefit from consolidation therapy or other approaches under clinical evaluation.

Nearly all patients will relapse without consolidation therapy.

In patients with meningitis, CSF culture should be negative before initiation of consolidation therapy.

Additional IP radioimmunoconjugates, vaccines, and targeted drugs are under clinical evaluation, primarily as consolidation therapy.

Age, organ dysfunction, and risk of cardiovascular and thrombotic complications would influence the choice of induction therapies as well as the choice of whether to consider consolidation therapies.

Fluconazole is preferred because studies comparing the two agents demonstrate higher rates of CSF sterilization during consolidation therapy (355) and less frequent relapse (365) during maintenance therapy in fluconazole recipients.

Wiernik PH, Banks PL, Case DC Jr, et al.: Cytarabine plus idarubicin or daunorubicin as induction and consolidation therapy for previously untreated adult patients with acute myeloid leukemia.

Induction and consolidation therapies result in molecular remission as measured by retrotranscriptase polymerase chain reaction (RT-PCR) for PML/RAR-alpha in the large majority of APL patients.

In patients younger than 70 years, alkylators are avoided up front to avoid stem cell toxicity with subsequent risks for cytopenias, secondary malignancies, or poor stem cell harvesting if transplantation is considered for consolidation therapy.

Morschhauser F, Radford J, Van Hoof A, et al.: Phase III trial of consolidation therapy with yttrium-90-ibritumomab tiuxetan compared with no additional therapy after first remission in advanced follicular lymphoma.

Heil G, Hoelzer D, Sanz MA, et al.: A randomized, double-blind, placebo-controlled, phase III study of filgrastim in remission induction and consolidation therapy for adults with de novo acute myeloid leukemia.

Meyers PA, Krailo MD, Ladanyi M, et al.: High-dose melphalan, etoposide, total-body irradiation, and autologous stem-cell reconstitution as consolidation therapy for high-risk Ewing's sarcoma does not improve prognosis.

Boulad F, Kernan NA, LaQuaglia MP, et al.: High-dose induction chemoradiotherapy followed by autologous bone marrow transplantation as consolidation therapy in rhabdomyosarcoma, extraosseous Ewing's sarcoma, and undifferentiated sarcoma.

The standard approach to treating children with APL utilizes induction therapy with ATRA, in conjunction with standard-dose cytarabine and daunorubicin, followed by consolidation therapy with ATRA and daunorubicin.

The goal of induction therapy is to achieve a complete remission by reducing the number of leukemic cells to an undetectable level; the goal of consolidation therapy is to eliminate any residual undetectable disease and achieve a cure.

After a minimum of 2 weeks of induction therapy with evidence of clinical improvement and a negative CSF culture after repeat lumbar puncture, amphotericin B and flucytosine can be discontinued and consolidation therapy initiated with fluconazole (AI).

Acute therapy (minimum 1- to 2-wk induction, longer if clinical improvement is delayed or at least 4--6 wks if CNS involved, followed by consolidation therapy): Amphotericin B deoxycholate, 1 mg/kg body weight IV once daily (AIII)

The results of this trial seem to confirm the existence of a graft versus leukemia effect for adult Ph1 negative ALL and support the use of sibling donor alloBMT as the consolidation therapy providing the greatest chance for long term survival for standard risk adult ALL in first remission.