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Number of courses of induction therapy independently predicts outcome after allogeneic transplantation for acute myeloid leukemia in first morphological remission.

Abstract
Whether the number of chemotherapy cycles required to obtain a first morphological remission affects prognosis of patients with acute myeloid leukemia (AML) remains controversial. To clarify how achievement of early remission might influence outcome of allogeneic hematopoietic cell transplantation (HCT), we studied 220 consecutive adults with AML in first morphological remission who underwent transplantation after myeloablative or nonmyeloablative conditioning to investigate how the number of standard- or high-dose induction courses required to achieve remission impacted post-HCT outcome. Three-year estimates of overall survival were 65% (95% confidence interval [CI] 56% to 73%), 56% (95% CI, 43% to 67%), and 23% (95% CI, 6% to 46%) for patients requiring 1 course, 2 courses, or >2 courses of induction therapy; corresponding relapse estimates were 24% (95% CI, 17% to 31%), 43% (95% CI, 31% to 55%), and 58% (95% CI, 30% to 78%), respectively. After covariate adjustment (minimal residual disease status, conditioning, age, cytogenetic disease risk, type of consolidation chemotherapy, pre-HCT karyotype, and pre-HCT peripheral blood count recovery), the hazard ratios for 2 or >2 induction courses versus 1 induction were 1.16 (95% CI, .73 to 1.85, P = .53) and 2.63 (95% CI, 1.24 to 5.57, P = .011) for overall mortality, and 2.10 (95% CI, 1.27 to 3.48, P = .004) and 3.32 (95% CI, 1.42 to 7.78, P = .006), respectively, for relapse. These findings indicate that the number of induction courses required to achieve morphological remission in AML adds prognostic information for post-HCT outcome that is independent of other prognostic factors.
AuthorsRoland B Walter, Brenda M Sandmaier, Barry E Storer, Colin D Godwin, Sarah A Buckley, John M Pagel, Mohamed L Sorror, H Joachim Deeg, Rainer Storb, Frederick R Appelbaum
JournalBiology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 21 Issue 2 Pg. 373-8 (Feb 2015) ISSN: 1523-6536 [Electronic] United States
PMID25278455 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
Chemical References
  • Myeloablative Agonists
Topics
  • Adolescent
  • Adult
  • Aged
  • Consolidation Chemotherapy (methods)
  • Female
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Induction Chemotherapy (methods)
  • Karyotyping
  • Leukemia, Myeloid, Acute (immunology, mortality, pathology, therapy)
  • Male
  • Middle Aged
  • Myeloablative Agonists (therapeutic use)
  • Prognosis
  • Recurrence
  • Remission Induction
  • Retrospective Studies
  • Survival Analysis
  • Transplantation Conditioning (methods)
  • Transplantation, Homologous
  • Treatment Outcome

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