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. 2010 Nov 1;116(21):5012-21.
doi: 10.1002/cncr.25263.

Adult patients with acute myeloid leukemia who achieve complete remission after 1 or 2 cycles of induction have a similar prognosis: a report on 1980 patients registered to 6 studies conducted by the Eastern Cooperative Oncology Group

Jacob M Rowe  1 , Haesook T Kim, Peter A Cassileth, Hillard M Lazarus, Mark R Litzow, Peter H Wiernik, Martin S Tallman
Affiliations

Adult patients with acute myeloid leukemia who achieve complete remission after 1 or 2 cycles of induction have a similar prognosis: a report on 1980 patients registered to 6 studies conducted by the Eastern Cooperative Oncology Group

Jacob M Rowe et al. Cancer. .

Abstract

Background: Patients with newly diagnosed acute myeloid leukemia (AML) often have residual leukemia in the bone marrow 10 to 14 days after the start of induction therapy. Some cooperative groups administer a second cycle of similar induction therapy on Day 14 if there is residual leukemia. It is a common perception that the presence of residual leukemia at that point predicts a worse prognosis irrespective of the therapy received. The objective of this study was to determine whether patients who required a second cycle of induction (given on or about Day 14) to achieve complete remission (CR) had a worse prognosis than patients who achieved CR after only 1 cycle, because a worse prognosis may alter postremission therapy.

Methods: Patients who were enrolled on 6 consecutive studies for AML that were conducted by the Eastern Cooperative Oncology Group (ECOG) between 1983 to 1993 received induction therapy. If residual leukemia was present in the bone marrow on the Day 14 after the start of induction, then patients were to receive a second cycle of identical induction therapy. All patients who achieved CR after 1 or 2 cycles received the identical postremission therapy.

Results: In each of the 6 ECOG studies, the long-term outcome was similar for patients who required 1 or 2 cycles of induction therapy to achieve CR, and their outcome was independent of other prognostic variables, such as age or karyotype.

Conclusions: The presence of residual leukemia in bone marrow 10 to 14 days after induction therapy did not predict a worse prognosis if patients received second, similar cycle of induction therapy and achieved CR.

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Figures

Figure 1
Figure 1
a. E 3483 study for newly diagnosed AML patients of less than 65 years. The only prospective study in young adults to include an observation arm post remission. b. PC486 study A pilot study for young adults of induction therapy to be followed by autologous transplant with in vitro purging for hydroxyl-peroxy-cyclophosphamide years c. E 3489 A major intergroup study designed to evaluate three prospective post-remission therapies given at approximately the same time point. d E 1490. A study evaluating the role of GM-CSF when given after marrow aplasia as evaluated by the marrow on day 10. e E 2491 / INT 0129. A North American intergroup study establishing the role of ATRA in induction and as maintenance therapy. For the purpose of this analysis patients who received ATRA in induction are not included. f E 3993 A study in older patients comparing three induction regimens and randomizing patients to GM-SCF or placebo as priming therapy.
Figure 2
Figure 2. Disease-free survival by number of cycles to achieve CR
a. E 3483 b. PC486 c. E 3489 d. E 1490 e. E 2491 / INT 0129 f. E 3993
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Comment in

References

    1. Grimwade D, Walker H, Harrison G, et al. The predictive value of hierarchical cytogenetic classification in older adults with acute myeloid leukemia (AML): analysis of 1065 patients entered into the United Kingdom Medical Research Council AML11 trial. Blood. 2001;98:1312–1320. - PubMed
    1. Slovak ML, Kopecky KJ, Cassileth PA, et al. Karyotypic analysis predicts outcome of preremission and postremission therapy in adult acute myeloid leukemia: a Southwest Oncology Group/Eastern Cooperative Oncology Group Study. Blood. 2000;96:4075–4083. - PubMed
    1. Kottaridis PD, Gale RE, Langabeer SE, Frew ME, Bowen DT, Linch DC. Studies of FLT3 mutations in paired presentation and relapse samples from patients with acute myeloid leukemia: implications for the role of FLT3 mutations in leukemogenesis, minimal residual disease detection, and possible therapy with FLT3 inhibitors. Blood. 2002;100:2393–2398. - PubMed
    1. Schnittger S, Schoch C, Dugas M, et al. Analysis of FLT3 length mutations in 1003 patients with acute myeloid leukemia: correlation to cytogenetics, FAB subtype, and prognosis in the AMLCG study and usefulness as a marker for the detection of minimal residual disease. Blood. 2002;100:59–66. - PubMed
    1. Frohling S, Schlenk RF, Stolze I, et al. CEBPA mutations in younger adults with acute myeloid leukemia and normal cytogenetics: prognostic relevance and analysis of cooperating mutations. J Clin Oncol. 2004;22:624–633. - PubMed