TY - JOUR
T1 - Characteristics and outcome of patients with acute myeloid leukemia refractory to 1 cycle of high-dose cytarabine-based induction chemotherapy
AU - Ravandi, Farhad
AU - Cortes, Jorge
AU - Faderl, Stefan
AU - O'Brien, Susan
AU - Garcia-Manero, Guillermo
AU - Verstovsek, Srdan
AU - Santos, Fabio P.S.
AU - Shan, Jianqin
AU - Brandt, Mark
AU - De Lima, Marcos
AU - Pierce, Sherry
AU - Kantarjian, Hagop
PY - 2010/12/23
Y1 - 2010/12/23
N2 - Pretreatment characteristics and outcome of patients treated with induction regimens containing high-dose ara-C (HiDAC) at M. D. Anderson Cancer Center refractory to 1 cycle of induction were compared with similar patients achieving a complete response (CR). Among 1597 patients treated with HiDAC-based induction from 1995 to 2009, 285 were refractory to 1 cycle. Median age was 59 years (range, 18-85 years). Induction regimens included HiDAC with anthracyclines (n = 181; 64%) or HiDAC with nonanthracycline chemotherapy (n = 104; 36%). Refractory patients were older (median age, 59 vs 56 years; P <.001), more likely with unfavorable cytogenetics (P<.001) and antecedent hematologic disorder (P <.001), and had a higher presentation white blood cell count (P =.04), but not a higher incidence of FLT3 mutations (P =.85), than those achieving CR. Forty-three patients (22%) responded to salvage (35 CR and 8 CR without platelet recovery). With a median follow-up of 72 months (range, 27-118 months) in responders, 11 are alive. Nineteen patients (7%) were alive and in CR for at least 6 months, including 9 who underwent allogeneic stem cell transplantation. On multivariate analysis, severe thrombocytopenia, leukocytosis, increasing marrow blast percentage, unfavorable cytogenetics, and salvage not including allogeneic stem cell transplantation were associated with a worse survival. Alternative strategies are needed for these patients.
AB - Pretreatment characteristics and outcome of patients treated with induction regimens containing high-dose ara-C (HiDAC) at M. D. Anderson Cancer Center refractory to 1 cycle of induction were compared with similar patients achieving a complete response (CR). Among 1597 patients treated with HiDAC-based induction from 1995 to 2009, 285 were refractory to 1 cycle. Median age was 59 years (range, 18-85 years). Induction regimens included HiDAC with anthracyclines (n = 181; 64%) or HiDAC with nonanthracycline chemotherapy (n = 104; 36%). Refractory patients were older (median age, 59 vs 56 years; P <.001), more likely with unfavorable cytogenetics (P<.001) and antecedent hematologic disorder (P <.001), and had a higher presentation white blood cell count (P =.04), but not a higher incidence of FLT3 mutations (P =.85), than those achieving CR. Forty-three patients (22%) responded to salvage (35 CR and 8 CR without platelet recovery). With a median follow-up of 72 months (range, 27-118 months) in responders, 11 are alive. Nineteen patients (7%) were alive and in CR for at least 6 months, including 9 who underwent allogeneic stem cell transplantation. On multivariate analysis, severe thrombocytopenia, leukocytosis, increasing marrow blast percentage, unfavorable cytogenetics, and salvage not including allogeneic stem cell transplantation were associated with a worse survival. Alternative strategies are needed for these patients.
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U2 - 10.1182/blood-2010-07-296392
DO - 10.1182/blood-2010-07-296392
M3 - Article
C2 - 20923968
AN - SCOPUS:78650655385
SN - 0006-4971
VL - 116
SP - 5818
EP - 5823
JO - Blood
JF - Blood
IS - 26
ER -