Impact of early remission by induction therapy on allogeneic stem cell transplantation for acute myeloid leukemia with an intermediate‐risk karyotype in first complete remission

Abstract

(2015), Impact of early remission by induction therapy on allogeneic stem cell transplantation for acute myeloid leukemia with an intermediate-risk karyotype in first complete remission. Eur J Haematol, AbstractFor patients with acute myeloid leukemia (AML) early achievement of remission during induction treatment is an important predictor for long-term outcome irrespective of the type of consolidation therapy employed. Here, we retrospectively examined the prognostic impact of early remission (ER) versus delayed remission (DR) in a cohort of 132 AML patients with an intermediate risk karyotype undergoing allogeneic stem cell transplantation (alloSCT) in first complete remission (CR1). In contrast to patients showing DR, patients achieving ER had a significantly higher 3-year overall survival (OS) and disease-free survival (DFS) of 76% versus 54% (p=0.03) and 76% versus 53% (p=0.03). Likewise, three years after alloSCT the cumulative incidence of relapse (CI-R) was significantly lower in the ER subgroup as compared to patients achieving DR, i.e. 10% versus 35% (p=0.004), whereas non-relapse mortality (NRM) did not differ significantly. Multivariate analysis identified DR as an independent prognosticator for an inferior DFS (HR 3.37, p=0.002) and a higher CI-R (HR 3.55, p=0.002). Taken together, these data may indicate that the rapid achievement of remission predicts a favorable outcome in patients with intermediate risk AML undergoing alloSCT in CR1. In turn, the adverse effect of DR may not be fully overcome by alloSCT.

Association Between Measurable Residual Disease in Patients With Intermediate-Risk Acute Myeloid Leukemia and First Remission, Treatment, and Outcomes

“…Number of cycles to achieve CR was another factor associated with prognosis . Our results suggested that needing 2 cycles to achieve CR was an independent risk factor for relapse, leukemia-free survival, and OS, in accordance with previous studies .…”

“…45,46 Our results suggested that needing 2 cycles to achieve CR was an independent risk factor for relapse, leukemiafree survival, and OS, in accordance with previous studies. 45,46 Old age was usually associated with poor prognosis because of unfavorable genetics, chemotherapeutic resistance, poor performance status, and frequent comorbidities. 47,48 In our study, patients in the chemotherapy group were significantly older than those in the auto-SCT and allo-SCT groups.…”

Metabolic Profiling during Acute Myeloid Leukemia Progression Using Paired Clinical Bone Marrow Serum Samples

“…A similar phenomenon was observed at the time of CR after the initial induction chemotherapy. CR is an important clinical endpoint after induction chemotherapy, which predicts a good prognosis [ 19 ]. However, our study demonstrated that the metabolic and nutritional microenvironments of AML did not significantly change despite the achievement of CR.…”

Allogeneic Hematopoietic Cell Transplantation and Cellular Therapy

“…Intermediate and high-risk features generally favor early transplantation because CR1 can be brief, and relapse is nearly always expected. However, even for AML in CR1, a greater number of chemotherapy cycles to achieve CR1 and measurable residual disease (MRD) pre-HCT compromises the likelihood of HCT success, both from NRM and higher risks of post-HCT relapse [29][30][31][32][33][34][35][36][37][38] . MDS patients have no alternative curative option despite the benefits of hypomethylating agents or other treatments.…”