Early mortality in acute myeloid leukemia

Acute megakaryocytic leukemia: What have we learned

“…Academic center and population-based studies in both children and adults have demonstrated that AMegL is a poor individual prognostic factor for overall survival in AML [5,12,14]. The majority of failures in achieving CR come from resistant disease with low response rates to salvage chemotherapy, instead of treatment related mortality [59]. Thus, while improvements in induction therapy are of benefit, the major improvement in the treatment of AMegL must come in post-remission therapy.…”

How Center Volumes Affect Early Outcomes in Acute Myeloid Leukemia

“…A landmark study of 5 Southwest Oncology Group (SWOG) clinical trials by Appelbaum et al 6 was among the first to demonstrate that older patients with non-M3 AML are more susceptible to EM and reported an EM rate of 12.1% (Table 1). 2,6,15,16,30 They also clearly demonstrated a relationship not only between age and EM but also between PS and EM. For example, the mortality of someone in age group 66 to 75 years varied on the basis of PS from 12% with a PS 0% to 47% with a PS of 3.…”

“…Monitoring for coagulopathy should be more frequent in patients with APL and those with monocytic differentiation due to increased risk of early bleeding. 16 Patients should have a differential with each daily CBC during chemotherapy, then every other day, once the white blood cell (WBC) count has recovered to > 500/mL. WBC differential should continue to be checked until a normal differential returns or until persistent leukemia is documented.…”

“…2,15,16 As noted above, improvements in supportive care and predictive models for EM have increased the capabilities of experienced hematologists to prevent and treat complications from induction therapy for AML. This could explain the decrease in EM noted by Othus and colleagues, but it remains to be understood why these improvements have not transferred over to the general population.…”

“…6,15,16 The challenges presented by EM and resistant disease have influenced who is offered induction chemotherapy and have led to age cutoffs around 70 years. 17,18 Alternative induction strategies, such as clofarabine, laromustine, decitabine, and tipifarnib, in this patient population have been met with modest success at best.…”