Characteristics and outcome of patients with acute myeloid leukemia refractory to 1 cycle of high-dose cytarabine-based induction chemotherapy.

Abstract

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.

• Authors: Farhad Ravandi, Jorge Cortes, Stefan Faderl, Susan O'Brien, Guillermo Garcia-Manero, Srdan Verstovsek, Fabio P S Santos, Jianqin Shan, Mark Brandt, Marcos de Lima, Sherry Pierce, Hagop Kantarjian
• Journal: Blood (Blood) Vol. 116 Issue 26 Pg. 5818-23; quiz 6153 (Dec 23 2010) ISSN: 1528-0020 [Electronic] United States
• PMID: 20923968 (Publication Type: Journal Article)

Chemical References

• Anthracyclines
• Cytarabine

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anthracyclines (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cytarabine (administration & dosage)
• Drug Resistance, Neoplasm
• Female
• Humans
• Leukemia, Myeloid, Acute (drug therapy)
• Male
• Middle Aged
• Remission Induction
• Survival Rate
• Treatment Outcome
• Young Adult