Ten-year outcome of patients with acute myeloid leukemia not treated with allogeneic transplantation in first complete remission

Abstract

The probability that adult patients with de novo acute myeloid leukemia (AML) receiving intensive chemotherapy in the absence of allogeneic hematopoietic stem cell transplantation (Allo-HCT) in first complete remission (CR1) will be disease-free at 10 years after diagnosis, a long-term surrogate of cure, is unknown. To address this question, we examined 2551 AML patients (1607 aged <60 years, and 944 aged ≥60 years) enrolled in Cancer and Leukemia Group B treatment protocols and the cytogenetics companion protocol 8461 between 1983 and 2004. At 10 years, 267 (16.6%) of patients aged <60 years and 23 (2.4%) of those aged ≥60 years were alive and disease-free. This disease-free AML group consisted predominantly of patients with core-binding factor AML with t(8;21)(q22;q22) or inv(16)(p13q22)/t(16;16)(p13;q22) and those with a normal karyotype. Occurrences of AML beyond 10 years were infrequent and associated with cytogenetic findings different from those at diagnosis. These data provide evidence that the frequency of long-term cure of AML is low among younger and especially older patients in the absence of Allo-HCT in CR1. In older patients not appropriate for Allo-HCT, these data provide further justification for early use of alternative treatments outside of intensive chemotherapy.

Graphical abstract

Figure 1.

Overview of AML patients enrolled on the CALGB 8461 cytogenetic study and receiving chemotherapy-based treatment on successive CALGB trials. Abnormal karyotype indicates other abnormal karyotypes (excluding CBF-AML); unknown karyotype (due to inadequate mitoses). APL, acute promyelocytic leukemia; CALGB, Cancer and Leukemia Group B; CBF, core-binding factor; CN, cytogenetically normal; sAML, secondary AML; tAML, therapy-related AML.