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. 2010 Dec 23;116(26):5818-23; quiz 6153.
doi: 10.1182/blood-2010-07-296392. Epub 2010 Oct 5.

Characteristics and outcome of patients with acute myeloid leukemia refractory to 1 cycle of high-dose cytarabine-based induction chemotherapy

Farhad Ravandi  1 , Jorge Cortes, Stefan Faderl, Susan O'Brien, Guillermo Garcia-Manero, Srdan Verstovsek, Fabio P S Santos, Jianqin Shan, Mark Brandt, Marcos de Lima, Sherry Pierce, Hagop Kantarjian
Affiliations

Characteristics and outcome of patients with acute myeloid leukemia refractory to 1 cycle of high-dose cytarabine-based induction chemotherapy

Farhad Ravandi et al. Blood. .

Abstract

Pretreatment characteristics and outcome of patients treated with induction regimens containing high-dose ara-C (HiDAC) at M. D. Anderson Cancer Center refractory to 1 cycle of induction were compared with similar patients achieving a complete response (CR). Among 1597 patients treated with HiDAC-based induction from 1995 to 2009, 285 were refractory to 1 cycle. Median age was 59 years (range, 18-85 years). Induction regimens included HiDAC with anthracyclines (n = 181; 64%) or HiDAC with nonanthracycline chemotherapy (n = 104; 36%). Refractory patients were older (median age, 59 vs 56 years; P < .001), more likely with unfavorable cytogenetics (P < .001) and antecedent hematologic disorder (P < .001), and had a higher presentation white blood cell count (P = .04), but not a higher incidence of FLT3 mutations (P = .85), than those achieving CR. Forty-three patients (22%) responded to salvage (35 CR and 8 CR without platelet recovery). With a median follow-up of 72 months (range, 27-118 months) in responders, 11 are alive. Nineteen patients (7%) were alive and in CR for at least 6 months, including 9 who underwent allogeneic stem cell transplantation. On multivariate analysis, severe thrombocytopenia, leukocytosis, increasing marrow blast percentage, unfavorable cytogenetics, and salvage not including allogeneic stem cell transplantation were associated with a worse survival. Alternative strategies are needed for these patients.

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Figures

Figure 1
Figure 1
OS after salvage chemotherapy. (A) For the 285 patients with primary refractory AML (to 1 cycle of HiDAC containing induction). (B) Complete remission duration for the 35 patients who achieved a CR after salvage chemotherapy
Figure 2
Figure 2
Landmark (2-month) analysis of OS after salvage for the responders (achieving CR) and nonresponders.
See this image and copyright information in PMC

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