Adult patients with acute myeloid leukemia who achieve complete remission after 1 or 2 cycles of induction have a similar prognosis

Abstract

Background Patients with newly diagnosed acute myeloid leukemia (AML) often have residual leukemia in the bone marrow on day 10–14 after the start of induction therapy. Some cooperative groups administer a second cycle of similar induction therapy on day 14 if there is residual leukemia. It is common perception that the presence of residual leukemia at that point predicts for a worse prognosis, irrespective of therapy given. The purpose of this study was to determine if patients who require a second cycle of induction to achieve complete remission (CR), given on or about day 14, have a worse prognosis than patients who achieve CR after only one cycle, since a worse prognosis might alter postremission therapy. Methods Patients registered to 6 consecutive studies for AML conducted by the Eastern Cooperative Oncology Group (ECOG) between 1983 to 1993 were treated with induction therapy. If the day 14 bone marrow had residual leukemia, patients were to receive a second cycle of identical induction therapy. All patients who achieved CR after one or two cycles, received the identical post-remission therapy. Results In each of the 6 studies the long-term outcome was similar for patients requiring one or two cycles of induction to achieve CR and this was independent of other prognostic variables such as age or karyotype. In conclusion The presence of residual leukemia in a day 10–14 bone marrow does not predict for a worse prognosis if a second similar cycle of induction therapy is administered and CR is achieved.

Routine interim disease assessment in patients undergoing induction chemotherapy for acute myeloid leukemia: Can we do better?

“…In CR, uniform consolidation is administered regardless of double vs. single induction therapy. Of 2000 ECOG patients treated in this way, the 5 and 10 year respective RFS and OS were similar, irrespective of the number of induction cycles to achieve first CR [21]. Similar observations regarding CR following single vs. double induction approaches (with identical therapy) were reported by Wheatley et al [22], in 1171 adult and pediatric patients enrolled in the MRC-AML-10 study.…”

Prognostic impact of day 15 blast clearance in risk-adapted remission induction chemotherapy for younger patients with acute myeloid leukemia: long-term results of the multicenter prospective LAM-2001 trial by the GOELAMS study group

“…Lastly, failure to achieve an adequate blast clearance at d15 could be considered as an adverse event for EFS and could also be used for stratification of post-remission therapy although a retrospective study from the Eastern Cooperative Oncology Group including 1980 patients (some of them over 60 years of age) enrolled in 6 trials between 1983 to 1993 showed that patients who achieved complete response after one or 2 cycles of induction had a similar prognosis. 23 The cut-off value of 5% has been a useful tool to identify high-risk patients. In a German study, Heil et al showed that among 305 patients who received idarubicin, standard cytarabine and etoposide, 68% had fewer than 5% d15 blasts, which is in accordance with our results.…”

Less Utilized Prognostic Markers in Acute Myeloid Leukemia

“…Many studies have reported delayed clearance of blasts is predictive of a worse prognosis (discussed in Rowe et al [73] , 2010). Residual leukemia present on day 14 bone marrow can be an early indicator of a highly resistant clone.…”