Very poor long‐term survival in past and more recent studies for relapsed AML patients: The ECOG‐ACRIN experience

Abstract

This study examines the long-term OS of relapsed AML patients who were enrolled to 9 successive ECOG-ACRIN trials for newly diagnosed AML, during 1984-2008. The objectives were to examine whether there is a trend of improvement in the survival of relapsed AML patients in the more recent studies and to search for prognostic factors that are associated with long-term OS after relapse. A total of 3,012 patients were enrolled, 1,779(59.1%) achieved CR1 and of these, 58.9% relapsed. The median follow-up was 9.7 years. The median OS from relapse was 0.5 years and the 5-year OS was 10(±1)%. These results were similar even for the most recent studies. A multivariate model showed that age (p<0.001), cytogenetics at diagnosis, duration of CR1 (p<0.001) and undergoing allogeneic transplantation were significantly associated with OS from relapse. Even among patients who relapsed with better prognostic factors; age<40 and CR1>12 months, there was no significant OS difference between the studies (p=0.48). In conclusion, this large cohort appears to confirm that the survival of AML patients post-relapse continues to be dismal and has not improved during the past quarter of a century. This article is protected by copyright. All rights reserved.

Real-World Outcomes of Patients with Refractory or Relapsed FLT3-ITD Acute Myeloid Leukemia: A Toulouse-Bordeaux DATAML Registry Study

“…AML patients unable to achieve CR or CRi after standard induction chemotherapy, or whose disease relapses after achieving remission, are likely to die from their disease. Ganzel et al showed that in a large cohort of AML patients included in nine trials from 1984 to 2008, the median OS from relapse was about 6 months, with a five-year OS of about 10% [20]. Apart from time to relapse or refractory status, FLT3-ITD mutation and a high-risk cytogenetic profile strongly impact prognosis [21].…”

Comparison of High-Dose Cytarabine, Mitoxantrone, and Pegaspargase (HAM-pegA) to High-Dose Cytarabine, Mitoxantrone, Cladribine, and Filgrastim (CLAG-M) as First-Line Salvage Cytotoxic Chemotherapy for Relapsed/Refractory Acute Myeloid Leukemia

“…However, about one-third of patients will not respond, and 50% or more of patients who do respond will eventually relapse [2]. Prognosis remains poor for patients with relapsed or refractory (R/R) AML, with median survival from relapse of approximately 6 months, and 2-and 5-year survival estimated at 16% and 10%, respectively [3]. Currently, no standard of care exists for the treatment of R/R AML, particularly for patients with good performance status who lack mutations that may predict for response to targeted therapy [1].…”

Optimizing survival outcomes with post‐remission therapy in acute myeloid leukemia

“…Although the use of reduced‐intensity conditioning regimens has enabled more patients with high‐risk AML to undergo allogeneic HCT, it may also contribute to higher rates of post‐transplant relapse . Unfortunately, relapses occur in both high‐risk and low‐risk patients, and outcomes are generally very poor for patients who experience relapse . Therefore, better post‐remission therapies are needed to prevent relapses and improve long‐term survival.…”