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

Abstract

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.

Continuous sequential infusion of fludarabine and cytarabine for elderly patients with acute myeloid leukaemia secondary to a previously diagnosed myelodysplastic syndrome

“…In the series from SWOG, for example, the CR rates were 24 and 52%, respectively [27]. However, the results from various clinical trials and single centre studies evaluating prognostic factors in elderly patients are conflicting [28]. The main reasons of discrepancy rely on different selection criteria used for enrolment or differences in treatment approaches.…”

Myelodysplastic syndrome and acute myeloid leukemia following adjuvant chemotherapy with and without granulocyte colony-stimulating factors for breast cancer

“…Growth factor products (G-CSF) continue to be among the top 15 drug expenditures in the United States [22]. The benefits of adjuvant chemotherapy made possible with G-CSF outweigh the risk of MDS/AML in patients with high risk of breast cancer relapse [8,17,51–54]. …”

Characterization and prognostic features of secondary acute myeloid leukemia in a population‐based setting: A report from the Swedish Acute Leukemia Registry

“…Although secondary AML has been associated with poor response to standard chemotherapy as well as poor survival, it is still debated whether secondary AML is an independent prognostic factor [4][5][6]. This is due to the fact that secondary AML is associated to factors that confer a poor prognosis such as high age and high-risk cytogenetics [2,7,8].…”