Prognostic factors and outcomes of adult patients with acute myeloid leukemia after first relapse

Abstract

The online version of this article has a Supplementary Appendix. BackgroundPatients with acute myeloid leukemia who are treated with conventional chemotherapy still have a substantial risk of relapse; the prognostic factors and optimal treatments after relapse have not been fully established. We, therefore, retrospectively analyzed data from patients with acute myeloid leukemia who had achieved first complete remission to assess their prognosis after first relapse. Design and MethodsClinical data were collected from 70 institutions across the country on adult patients who were diagnosed with acute myeloid leukemia and who had achieved a first complete remission after one or two courses of induction chemotherapy. ResultsAmong the 1,535 patients who were treated with chemotherapy alone, 1,015 relapsed. Half of them subsequently achieved a second complete remission. The overall survival was 30% at 3 years after relapse. Multivariate analysis showed that achievement of second complete remission, salvage allogeneic hematopoietic cell transplantation, and a relapse-free interval of 1 year or longer were independent prognostic factors. The outcome after allogeneic transplantation in second complete remission was comparable to that after transplantation in first complete remission. Patients with acute myeloid leukemia and cytogenetic risk factors other than inv(16) or t(8;21) had a significantly worse outcome when they did not undergo salvage transplantation even when they achieved second complete remission. ConclusionsWe found that both the achievement of second complete remission and the application of salvage transplantation were crucial for improving the prognosis of patients with acute myeloid leukemia in first relapse. Our results indicate that the optimal treatment strategy after first relapse may differ according to the cytogenetic risk.Key words: acute myeloid leukemia, allogeneic hematopoietic cell transplantation, first relapse, second remission, cytogenetic risk. 2010;95(11):1857-1864. doi:10.3324/haematol.2010 This is an open-access paper. Citation: Kurosawa S, Yamaguchi T, Miyawaki S, Uchida N, Sakura T, Kanamori H, Usuki K, Yamashita T, Okoshi Y, Shibayama H, Nakamae H, Mawatari M, Hatanaka K, Sunami K, Shimoyama M, Fujishima N, Maeda Y, Miura I, Takaue Y, and Fukuda T. Prognostic factors and outcomes of adult patients with acute myeloid leukemia after first relapse. Haematologica Prognostic factors and outcomes of adult patients with acute myeloid leukemia after first relapse

Influence of molecular subgroups on outcome of acute myeloid leukemia with normal karyotype in 141 patients undergoing salvage allogeneic stem cell transplantation in primary induction failure or beyond first relapse

“…Patients with PIF had a promising outcome. In relapsed CN-AML, results after alloHSCT compared favorably to published data, 8,9,25,[38][39][40] although the prognostic significance of NPM1 mut and FLT3-ITD was carried through. Confirmation of these findings in a larger cohort, and integration with other genetic aberrations and leukemogenic mechanisms are warranted for a more precise estimation of individual prognosis.…”

The European LeukemiaNet AML Working Party consensus statement on allogeneic HSCT for patients with AML in remission: an integrated-risk adapted approach

“…However, only 249 out of 667 (37%) relapsing patients entered second CR and less than 50% of those CR2 patients proceeded to allografting (n=109), indicating that ultimately only 15% of relapsed patients received the preferred treatment option. More recent observations were reported by Kurosawa et al (116) and by Armistead (117), who detailed results from 599 relapsing patients treated at MD Anderson. Given the restricted application of alloHSCT in CR2 and in view of the dismal outcome in patients, who did not proceed to alloHSCT, allografting would therefore preferentially need to be considered and weighed in patients in first CR ( Figure 1).…”

Duration of first remission and hematopoietic cell transplantation-specific comorbidity index but not age predict survival of patients with AML transplanted in CR2: a retrospective multicenter study

“…This observation is consistent with other studies investigating the influence of cytogenetics on post transplant outcome for AML in CR2. 8,9 In conclusion, duration of CR1 and the HCT-CI pre-allogeneic transplant comorbidity score are prognostic for OS in patients 100% 80% 60% 40% 0 12 24 36 48 60 84 72 96 0 12 24 36 48 60 84 72 transplanted for AML in CR2 as shown for both cohorts, and these results could be used to guide decision making concerning transplant. The impact of age on OS was different for the two cohorts, and this discrepancy requires further prospective investigation with a detailed analysis of disease-related risk factors, potential referral biases and transplant methodology.…”