Long‐term outcomes for patients with acute myeloid leukemia: A single‐center experience from <scp>AIIMS</scp>, <scp>I</scp>ndia

Bahl, Ankur; Sharma, Atul; Raina, Vinod; Kumar, Lalit; Bakhshi, Sameer; Gupta, Ritu; Kumar, Rajeev

doi:10.1111/ajco.12333

Cited by 24 publications

(17 citation statements)

References 43 publications

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“…6,7,9,21 An earlier retrospective analysis of outcome in AML from our institution including both adults and children showed induction mortality of 18.8%. 22 Induction mortality in present study was 9%, which seems reasonable in our setting for relapsed AML in children. Although, in general, the patients with AML are typically hospitalized for induction chemotherapy and remains inpatient till recovery of blood counts, a study in adults has already shown that outpatient management after early discharge is feasible with reduced economic burden.…”

Section: F I G U R Esupporting

confidence: 57%

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Outpatient ADE (cytarabine, daunorubicin, and etoposide) is feasible and effective for the first relapse of pediatric acute myeloid leukemia: A prospective, phase II study

Garg

Ganguly

Vishnubhatla

et al. 2020

Pediatric Blood & Cancer

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Background Approximately 40% children with acute myeloid leukemia (AML) invariably relapse, after attaining the first complete remission (CR), with dismal long‐term outcome. There is little consensus regarding choice of optimal induction chemotherapy regimen for relapsed pediatric AML. Procedure A prospective single arm phase II study (CTRI/2017/02/007757) was carried out at our center to evaluate the safety and efficacy of outpatient cytarabine, daunorubicin, and etoposide (ADE) regimen in pediatric AML (≤18 years) at the first relapse. Response evaluation was done by bone marrow aspiration morphology along with minimal residual disease (MRD) assessment. All adverse events including need and duration of hospitalization, transfusion support, and antimicrobial use were recorded. Results Total 45 patients were included with median age of 12 years. The CR rate of the cohort was 66% and 54% of patients were MRD negative. The estimated 2‐year event‐free survival (EFS) and overall survival (OS) were 29% (±7%) and 34% (±7%), respectively. The presence of fever at relapse was associated with inferior CR rate (P = .001), positive MRD (P = .01), and inferior EFS (P = .02), while not achieving nadir absolute neutrophil count of zero during induction was associated with inferior CR rate (P = .03) and inferior OS (P = .04). Approximately all patients developed ≥Grade 3 cytopenia and febrile neutropenia. Twenty‐six (59%) patients required hospitalization for management of toxicity and there were four (9%) deaths attributed to infection. Conclusion ADE is an effective induction regimen for pediatric AML patients at the first relapse with reasonable toxicity profile. Outpatient administration of the regimen is feasible in the presence of proper support structure and rigorous follow up.

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Section: F I G U R Esupporting

confidence: 57%

“…Although fever was present at baseline in 22 The common nonhematological toxicities (Grade 3/4) in our study were vomiting and mucositis in four patients each. Twelve patients had hypokalemia and three patients had hyponatremia.…”

Section: Toxicity and Supportive Carementioning

confidence: 54%

Outpatient ADE (cytarabine, daunorubicin, and etoposide) is feasible and effective for the first relapse of pediatric acute myeloid leukemia: A prospective, phase II study

Garg

Ganguly

Vishnubhatla

et al. 2020

Pediatric Blood & Cancer

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“…The median age at diagnosis in Latin American countries or developing countries is very similar to ours. Brazil has reported a median age at diagnosis of 33-44 years [27,28], and for other low-middle-income countries such as India and Malaysia the median age of patients with AML has been observed to be 40 and 39 years, respectively [29,30]. The exact cause of this age difference is unclear.…”

Section: Acute Myelogenous Leukemiamentioning

confidence: 99%

Geographic Hematology: Some Observations in Mexico

et al. 2018

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In 1963 Jean Bernard introduced the concept of “geographic hematology” and distinguished 2 branches, i.e., “ethnic hematology,” which deals with differences between populations, and “environmental hematology,” which considers factors such as food habits, infections, and others. Both of these branches have implications in the distribution of hematological diseases worldwide. In comparison with Caucasian populations, in Mexico a significantly higher prevalence of acute lymphoblastic, acute promyelocytic, and acute megakaryoblastic leukemias has been described. The rate of chronic myeloid leukemia seems to be as high as that reported in Caucasian populations, while other myeloproliferative neoplasias are significantly less frequent in Mexico. Significantly lower prevalences of hairy cell leukemia, chronic lymphocytic leukemia, multiple myeloma, and Waldenström’s macroglobulinemia have been reported from Mexico. Regrettably, the influence of drug companies interested in selling their new and expensive drugs has resulted in both overdiagnosis of some diseases and overidentification of the refractory forms of some of these conditions to justify the use of unnecessary drugs.

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“…In addition, AML patients who respond to chemotherapy often relapse later. 3 – 6 Relapse is defined as >5% blast cells in bone marrow, or reappearance of blast cells in blood, or development of blasts from any sites other than bone marrow after CR is achieved. Relapse occurs usually within first 3 years from the end of the chemotherapy, 3 especially in young patients.…”

Section: Introductionmentioning

confidence: 99%

Bax, Bcl-2, and Bax/Bcl-2 as prognostic markers in acute myeloid leukemia: are we ready for Bcl-2-directed therapy?

Kulsoom¹,

Shamsi²,

Afsar³

et al. 2018

CMAR

106

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PurposeMany anticancer drugs induce apoptosis in malignant cells, and resistance to apoptosis could lead to suboptimal or no therapeutic benefit. Two cytoplasmic proteins, B-cell lymphoma protein 2 (Bcl-2)-associated X (Bax) and Bcl-2, act as a promoter and an inhibitor of apoptosis, respectively. Both Bax and Bcl-2 as well as their ratio have been regarded as prognostic markers in various cancers. However, conflicting results have been reported. A clear understanding of apoptosis has also become crucial due to reports about anti-Bcl-2 chemotherapy. We explored the relationship of Bax and Bcl-2 gene expression and their ratio with the therapeutic response in acute myeloid leukemia (AML) patients.Patients and methodsBone marrow and/or blood samples from 90 AML patients treated with cytarabine and daunorubicin were included. Expression of Bax and Bcl-2 was determined through real-time polymerase chain reaction by using ΔΔCt method of relative expression.ResultsBax and Bcl-2 expression among marrow and blood samples correlated with each other (rs=0.5, p<0.01). Although bone marrow expression of Bax and Bcl-2 tended to remain higher among responders (median 1.01 and 0.29, respectively) as compared to non-responders (median 0.66 and 0.24, respectively), the difference failed to reach statistical significance (U=784.5 and 733; p=0.68 and 0.28, respectively). Conversely, Bax/Bcl-2 ratio was higher among poor responders (median 3.07 vs 1.78), though again failed to reach statistical significance (U=698.5, p=0.07).ConclusionExpression of Bax and Bcl-2 does not differ significantly among AML patients treated with cytarabine and daunorubicin in terms of remission, relapse, resistance, overall survival, and disease-free survival, thus questioning the utility of emerging anti-Bcl-2 therapy.

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Long‐term outcomes for patients with acute myeloid leukemia: A single‐center experience from AIIMS, India

Abstract: This is one of the largest single-center studies reflecting more accurately the outcome of AML in India. These results are likely due to uniform treatment protocols, intensification of induction and post-remission treatments with comprehensive supportive care.

Cited by 24 publications

References 43 publications

Outpatient ADE (cytarabine, daunorubicin, and etoposide) is feasible and effective for the first relapse of pediatric acute myeloid leukemia: A prospective, phase II study

Outpatient ADE (cytarabine, daunorubicin, and etoposide) is feasible and effective for the first relapse of pediatric acute myeloid leukemia: A prospective, phase II study

Geographic Hematology: Some Observations in Mexico

Bax, Bcl-2, and Bax/Bcl-2 as prognostic markers in acute myeloid leukemia: are we ready for Bcl-2-directed therapy?

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