Remission rate and survival in acute myeloid leukemia: Impact of selection and chemotherapy

Abstract

113 patients with acute myelogenous leukemia (AML), representing 82% of the total cohort of AML patients within the geographical area of northern Sweden, were recorded. The total complete remission (CR) rate was 47.8 %, and median survival was 4 months. The probability of long‐term survival for all patients without exclusions was only 5%. Thus, the results from this study differ strongly from data on patient outcome in most therapy studies in AML, where the influence of patient selection on the results is larger. The median age in our patients was 63 years, which is also higher than in most other studies. Elderly patients had a low CR rate (24% in patients >70 yr), but remission duration was similar in the different age groups. Patients treated according to “high‐dose” protocols had a CR rate of 64%, while only 14% of less aggressively treated patients achieved remission. A better response rate after more aggressive chemotherapy was evident also in elderly patients. CR rate was 81% in patients below 60 yr of age who had no antecedent blood disorder and who had had symptoms for less than 3 months. Other variables with prognostic implications were: cytogenetic subgroup, antecedent hematological disease, and level of serum ferritin. High serum ferritin was associated with short CR duration. Ferritin is produced by the leukemic cells and could be regarded as a marker for leukemic activity.

Intensive chemotherapy does not benefit most older patients (age 70 years or older) with acute myeloid leukemia

“…[1][2][3][4][5] Patients with higher risk myelodysplastic syndrome (MDS), particularly those with Ն 20% blasts, are often treated like AML. The World Health Organization classification categorizes patients with Ն 20% blasts as having AML.…”

“…35%-55%), intensive chemotherapy is associated with a high incidence of 4-week mortality and with 3-to 5-year survival rates of Ͻ 10%. 5,8,[15][16][17][18][19][20] Recent research trends have emphasized investigational lowintensity and targeted therapies in older patients with AML, hoping to reduce the early mortality and to improve the benefit/risk ratio for long-term survival. [21][22][23][24][25][26][27][28][29][30] Investigational therapies included lowdose cytarabine, arsenic trioxide, gemtuzumab ozogamycin, clofarabine, hypomethylating agents, and others.…”

Epigenetic changes: a common theme in acute myelogenous leukemogenesis

“…Until now, treatment of AML consists of cytotoxic “chemotherapy” and might cure 20–75% of patients younger than 60 years depending primarily on leukemia-cell cytogenetics. However, in elderly patients despite achievement of reasonable complete response rates (CR rates 35%-55%), intensive chemotherapy is associated with a high incidence of 4-week mortality and with 3- to 5-year survival rates of < 10% [2-4]. Currently is estimated that 7.820 men and 6.770 women will be diagnosed and 10.370 (men and women) will die of AML in 2013 in US.…”

Characterization and analysis of the outcome of adults with acute myeloid leukemia treated in a Brazilian University hospital over three decades

“…Among the other variables, age has proved to be an important prognostic factor in many studies (4,(22)(23)(24)(25). In addition, AML with multilineage dysplasia has been associated with a poor prognosis.…”