Salvage treatment for refractory or relapsed acute myeloid leukemia: a 10-year single-center experience

Abstract

OBJECTIVES: The outcomes of refractory and relapsed acute myeloid leukemia (AML) patients in developing countries are underreported, even though the similar classic regimens are widely used. METHODS: We conducted a retrospective comparison of ''MEC'' (mitoxantrone, etoposide, and cytarabine) and ''FLAG-IDA'' (fludarabine, cytarabine, idarubicin, and filgrastim) in adults with first relapse or refractory AML. RESULTS: In total, 60 patients were included, of which 28 patients received MEC and 32 received FLAG-IDA. A complete response (CR) rate of 48.3% was observed. Of the included patients, 16 (27%) died before undergoing bone marrow assessment. No statiscally significant difference in CR rate was found between the two protocols (p=0.447). The median survival in the total cohort was 4 months, with a 3-year overall survival (OS) rate of 9.7%. In a multivariable model including age, fms-like tyrosine kinase 3 (FLT3) status, and stem-cell transplantation (SCT), only the last two indicators remained significant: FLT3-ITD mutation (hazard ratio [HR] =4.6, po0.001) and SCT (HR=0.43, p=0.01). CONCLUSION: In our analysis, there were no significant differences between the chosen regimens. High rates of early toxicity were found, emphasizing the role of supportive care and judicious selection of patients who are eligible for intensive salvage therapy in this setting. The FLT3-ITD mutation and SCT remained significant factors for survival in our study, in line with the results of previous studies.

Increasing access to allogeneic hematopoietic cell transplant: an international perspective

“…30 It is pos si ble that care deliv eryrelated fac tors may have con trib uted to the high pro por tion of deaths from infec tions seen in HMIC/LMIC/LIC set tings (eg, lack of ade quate inten sive care sup port). 25,30,32 Alternatively, worse mac ro eco nomic indi ca tors may reflect deficiencies in train ing, expe ri ence, or staffing mod els in cen ters in resource-constrained set tings. On a patient level, lower socio eco nomic sta tus may be asso ci ated with adverse out comes owing to chronic stress, low edu ca tional level, unaffordability of med i ca tions, and dif fi cul ties in reaching the trans plant cen ter.…”

A Combined Histone Deacetylases Targeting Strategy to Overcome Venetoclax Plus Azacitidine Regimen Resistance in Acute Myeloid Leukaemia: Three Case Reports

“…AML is a disease caused by the blocked differentiation of myeloid haematopoietic stem cells and the clonal proliferation of primitive or immature myeloid cells in the bone marrow (BM). With current chemotherapies, approximately 10% to 40% of newly diagnosed AML patients cannot achieve complete remission (CR), and more than 50% of AML patients will ultimately relapse ( 1 ). Although higher clinical responses may be achieved with salvage intensive chemotherapy, durability is generally short lived and counterbalanced by higher toxicities, especially for elderly individuals with poor performance status.…”

Estudo multicêntrico retrospectivo em leucemia mieloide aguda: abordando de forma abrangente variáveis demográficas, clínicas e genéticas de adultos tratados intensivamente

“…Disease relapse is associated with abysmal prognosis in Brazilian centres(104), with 90% of relapsed patients dying within 3 years. Nonetheless, allogeneic HSCT rates for haematological disease in Brazil are low, and the majority of stem cell transplantation (21-100 individuals per 10 million inhabitants) are autologous.…”