Intensive chemotherapy of poor prognosis myelodysplastic syndromes (MDS) and acute myeloid leukemia following MDS with idarubicin and cytarabine

Ruutu, Tapani; Hänninen, A.; Järventie, G.; Koistinen, Pirjo; Koivunen, E; Kätkä, K.; Nousiainen, Tapio; Oksanen, Kalevi; Pelliniemi, Tarja‐Terttu; Remes, Kari; Timonen, T.; Volin, Liisa; Elonen, Erkki

doi:10.1016/s0145-2126(96)00116-6

Cited by 33 publications

(19 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Overall results of IC in the present study are similar to those previously reported in the literature in de novo MDS, where CR rates have ranged from 40% to 60% and median CR durations of 10-15 months were observed (Martiat et al, 1988;Gajewski et al, 1989;Hoyle et al, 1989;Michels et al, 1985;De Witte et al, 1990Fenaux et al, 1991;Bernstein et al, 1993;Aul et al, 1994Aul et al, , 1995bRuutu et al, 1994;Hiddeman et al, 1995;Estey et al, 1995;Gore et al, 1995;Wattel et al, 1996b;Gardin et al, 1997). These results are poorer than those obtained in de novo AML (Gajewski et al, 1989;Fenaux et al, 1991;Bishop et al, 1997).…”

Section: Discussionsupporting

confidence: 85%

Long‐term follow‐up of de novo myelodysplastic syndromes treated with intensive chemotherapy: incidence of long‐term survivors and outcome of partial responders

Wattel¹,

Botton²,

Laı̈³

et al. 1997

Br J Haematol

View full text Add to dashboard Cite

Summary. The percentage of long-term survivors after intensive chemotherapy and the outcome of MDS patients who achieve partial remission (PR) with intensive chemotherapy (IC) are not known.Between 1981 and 1996 we treated 99 patients with de novo MDS who had high-risk MDS or progression to AML, with IC. 41 (41%) achieved CR, 16 (16%) achieved partial remission (PR), 26 (26%) had failure, and 16 (16%) died in aplasia. Eight of the patients who achieved CR were autografted, three were allografted and the remaining cases received moderate consolidation chemotherapy.After IC, the 16 PR patients fulfilled the criteria for RA in 15 cases and CMML in one case. Median PR duration was 17 months, and three PR were > 3 years (39, 50þ, 82þ months). Median actuarial survival of patients who achieved PR and CR was 18 months and 20 months from the onset of IC, respectively (difference not significant).Of the 71 patients treated before 1993, with sufficient follow-up, 10 (14%) had survived > 4 years (long-term survivors). Four of them were alive in first CR after 49þ to 110þ months and probably cured, two were alive in PR after 50þ and 82þ months and four had died after 49-78 months. Long-term survivors were characterized by a significantly higher incidence of RAEB-T at diagnosis, and with normal or favourable cytogenetic findings. In patients with RAEB-T at diagnosis included before 1993, 8/23 (35%) cases who had no unfavourable karyotype had survived > 4 years. Our findings suggest that MDS patients who achieve PR with IC, and not only those who achieve CR, can benefit from this type of treatment. The percentage of long-term survivors remains low, however, and is almost restricted to patients with RAEB-T at diagnosis and no unfavourable karyotype.

show abstract

Section: Discussionsupporting

confidence: 85%

Long‐term follow‐up of de novo myelodysplastic syndromes treated with intensive chemotherapy: incidence of long‐term survivors and outcome of partial responders

Wattel¹,

Botton²,

Laı̈³

et al. 1997

Br J Haematol

View full text Add to dashboard Cite

show abstract

“…17 Remission induction chemotherapy, as is generally used in AML, may induce complete remissions in MDS in 15-64% of cases. [7][8][9]18 Although CR rates vary widely between studies they appear to be lower as compared to those attained in patients with de novo AML. 19 In addition, remission duration is usually short (median less than 1 year).…”

Section: Discussionmentioning

confidence: 99%

“…However, on average, CR rates are lower than in AML. [7][8][9] Hematological recovery following induction therapy is usually characterized by polyclonal hematopoiesis, but the median remission duration is short (12 months). Prolonged pancytopenia resulting in a greater hypoplastic death rate is one explanation for the reduced CR rate.…”

Section: Introductionmentioning

confidence: 99%

A randomized study of granulocyte colony-stimulating factor applied during and after chemotherapy in patients with poor risk myelodysplastic syndromes: a report from the HOVON Cooperative Group

Ossenkoppele

Holt

Verhoef³

et al. 1999

Leukemia

View full text Add to dashboard Cite

The purpose of this study was to determine the safety and efficacy of filgrastim as an adjunct to induction and consolidation chemotherapy in poor risk patients with myelodysplastic syndrome (MDS). Filgrastim was given both during and after chemotherapy with the objective to accelerate hematopoietic repopulation and enhance the efficacy of chemotherapy. In a prospective randomized multicentre phase II trial, a total of 64 patients with poor risk primary MDS were randomized to receive either granulocyte colony-stimulating factor (G-CSF, filgrastim, AMGEN, Breda, The Netherlands) 5 g/kg/day subcutaneously or no G-CSF in addition to daunomycin (30 mg/m 2 /days 1, 2 and 3 intravenous bolus) and cytarabine (200 mg/m 2 days 1-7, continuous infusion). The overall complete response rate was 63%: 73% for patients receiving filgrastim as compared to 52% in the standard arm (P = 0.08). Overall survival at 2 years was estimated at 29% for patients assigned to the filgrastim arm and 16% for control patients (P = 0.22). The median time for recovery of granulocytes towards 1.0 × 10 9 /l post-chemotherapy was 23 days in the filgrastim-treated patients vs 35 days in the standard arm (P = 0.015). There were no differences in time of platelet recovery, length of hospital stay, duration of antibiotic use or infectious complications between the two treatment groups. However the earlier recovery of neutrophils in the filgrastim group was associated with a reduced interval of 9 days between the induction and consolidation cycle. In patients with poor risk MDS the use of filgrastim during and after induction therapy results in a significantly reduced neutrophil recovery time. Further study may be warranted to see if the apparent trend of the improved response to chemotherapy in combination with filgrastim can be confirmed in greater number of patients and to assess the effect of the addition of filgrastim on survival.

show abstract

“…Furthermore, despite advances in supportive care, the response appears no better than that reported in similar patients over a decade ago. 14,15 In addition, our patients experienced poor durability, with only a 64% chance of surviving 1 year, and a median DFS of 11 months if they attained remission with the first cycle of therapy and only 6 months if they required a second cycle to attain CR. This finding is best reflected in the cumulative incidence of recurrence curve, which, unlike a Kaplan-Meier curve, is able to take into account the competing risk of dying while in disease remission.…”

Section: (8%)mentioning

confidence: 87%

Outcomes of patients who undergo aggressive induction therapy for secondary acute myeloid leukemia

Rizzieri

O’Brien

Broadwater

et al. 2009

Cancer

View full text Add to dashboard Cite

BACKGROUND: Response and survival in 96 patients with secondary acute myeloid leukemia (sAML) who received aggressive induction chemotherapy was reviewed. METHODS: The median follow‐up of survivors was 2.3 years. A total of 70 (73%) patients achieved a morphologic complete remission (CR) confirmed by absence of leukemic blasts by flow cytometry. RESULTS: For all 96 patients, the median event‐free survival (EFS) was 8 months, and overall survival (OS) was 13.6 months (range, 1‐119 months). Eight patients died shortly after induction therapy because of disease or side effects, and 13 are currently in continuous first remission. The median disease‐free survival (DFS) for all 70 patients who achieved a morphologic CR was 9 months (range, 1‐51 months), with a 64% chance of surviving 1 year. Patients with AML after previous chemotherapy or radiation therapy had a higher morphologic remission rate compared with those arising from myelodysplastic syndrome or myeloproliferative disease (82% vs 62%; P = .027). However, among the patients from the 2 groups who attained a morphologic remission, there was no difference in terms of CR rate (P = .94), DFS, EFS, or OS (P = .55, .83, and .71, respectively). This is a similar DFS to the group of 7 patients who went directly to ablative allogeneic transplant rather than having induction therapy first. In this population of patients who received aggressive chemotherapy, Charlson comorbidity index or a higher number of factors recognized as high risk in leukemia patients did not affect the chance of OS, DFS, and EFS, although having more recognized leukemia risk factors was related to a lower chance of surviving 1 year. However, it is important to note that those with higher comorbidity indexes were underrepresented in this aggressively treated cohort. CONCLUSIONS: The data from the current study demonstrate that many patients with sAML can tolerate aggressive induction therapy and attain remission, but duration of response and the chance of long‐term survival remain poor. Cancer 2009. © 2009 American Cancer Society.

show abstract

Intensive chemotherapy of poor prognosis myelodysplastic syndromes (MDS) and acute myeloid leukemia following MDS with idarubicin and cytarabine

Cited by 33 publications

References 21 publications

Long‐term follow‐up of de novo myelodysplastic syndromes treated with intensive chemotherapy: incidence of long‐term survivors and outcome of partial responders

Long‐term follow‐up of de novo myelodysplastic syndromes treated with intensive chemotherapy: incidence of long‐term survivors and outcome of partial responders

A randomized study of granulocyte colony-stimulating factor applied during and after chemotherapy in patients with poor risk myelodysplastic syndromes: a report from the HOVON Cooperative Group

Outcomes of patients who undergo aggressive induction therapy for secondary acute myeloid leukemia

Contact Info

Product

Resources

About