Causes of initial remission induction failure in acute myelogenous leukemia

Abstract

One-hundred and sixty-one of 378 previously untreated patients with acute myelogenous leukemia (AML) failed to enter complete remission with a combination of anthracycline, cytosine arabinoside, vincristine, and prednisone between 1973 and 1979. Thirty-six of the failing patients (22%) were considered chemotherapy failures. As in the past, the remainder failed largely because of death from infection. However, despite the routine use of prophylactic platelet transfusions, hemorrhage was a major cause of death in 33%. Thirty-seven percent of the fatal infections were due to fungi and the incidence of fungal infection was as high during the second week of treatment as later. Age greater than 50 yr predisposed to fatal infection but not chemotherapy failure, while the presence of an antecedent hematologic disorder increased the risk of both fatal fungal infection and resistance to chemotherapy. Patients with an initial white blood cell count of greater than or equal to 25000/microliter were more likely to die of hemorrhage at all times during treatment. Improvement in supportive care remains crucial if improved complete rates are to be forthcoming in previously untreated patients.

Multiple platelet defects identified by flow cytometry at diagnosis in acute myeloid leukaemia

“…Although AML patients have an increased bleeding tendency (Estey et al, 1982;Guarini et al, 1987), there was no evidence of elevated sP-selectin/platelet in plasma as an indication of recent platelet degranulation in 80% of the patients. In 10 patients sP-selectin/platelet was increased.…”

Macular Haemorrhage in Adult Acute Leukaemia Patients at Presentation and the Risk of Subsequent Intracranial Haemorrhage

“…6%). Tornebohm et al (1993) found that only 10% of their acute leukaemia patients died of haemorrhage at any site during the first month; and, in the series of AML patients reported by Estey et al (1982), 5 . 8% of the patients died of ICH, mostly within the first month.…”

Acute Myelogenous Leukemia in the Elderly

“…Remission Induction Failure Failure to achieve CR is usually due to (a) primary chemotherapy resistance or (b) early death during the aplastic period. When cases of MDS are excluded, no apparent differences in the sensitivity to chemotherapeutic drugs exist in leukemic cells from older or younger individuals 71 . Elderly individuals have an increased number of early deaths during the first weeks of induction therapy, most commonly due to infections and less frequently from hemorrhage 71 .…”

“…When cases of MDS are excluded, no apparent differences in the sensitivity to chemotherapeutic drugs exist in leukemic cells from older or younger individuals 71 . Elderly individuals have an increased number of early deaths during the first weeks of induction therapy, most commonly due to infections and less frequently from hemorrhage 71 . Unfortunately, blasts from patients with MDS/AML have a high incidence of drug resistance to standard induction programs.…”

“…Unfortunately, blasts from patients with MDS/AML have a high incidence of drug resistance to standard induction programs. Therefore, as patients with MDS/AML have longer periods of neutropenia following induction than patients with de novo AML, there is a resultant high rate of death from bacterial and fungal infections 54 , 71 . It must be noted that, following induction chemotherapy, most of these patients recover hematopoiesis with a myelodysplastic rather than with a normal bone marrow.…”