Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Apr 6:75:e1566.
doi: 10.6061/clinics/2020/e1566. eCollection 2020.

Salvage treatment for refractory or relapsed acute myeloid leukemia: a 10-year single-center experience

Wellington Fernandes da Silva  1 , Lidiane Inês da Rosa  1 , Fernanda Salles Seguro  1 , Douglas Rafaele Almeida Silveira  2 , Israel Bendit  2 , Valeria Buccheri  1 , Elvira Deolinda Rodrigues Pereira Velloso  1 , Vanderson Rocha  1 , Eduardo M Rego  1
Affiliations

Salvage treatment for refractory or relapsed acute myeloid leukemia: a 10-year single-center experience

Wellington Fernandes da Silva et al. Clinics (Sao Paulo). .

Erratum in

Abstract

Objectives: The outcomes of refractory and relapsed acute myeloid leukemia (AML) patients in developing countries are underreported, even though the similar classic regimens are widely used.

Methods: We conducted a retrospective comparison of "MEC" (mitoxantrone, etoposide, and cytarabine) and "FLAG-IDA" (fludarabine, cytarabine, idarubicin, and filgrastim) in adults with first relapse or refractory AML.

Results: In total, 60 patients were included, of which 28 patients received MEC and 32 received FLAG-IDA. A complete response (CR) rate of 48.3% was observed. Of the included patients, 16 (27%) died before undergoing bone marrow assessment. No statiscally significant difference in CR rate was found between the two protocols (p=0.447). The median survival in the total cohort was 4 months, with a 3-year overall survival (OS) rate of 9.7%. In a multivariable model including age, fms-like tyrosine kinase 3 (FLT3) status, and stem-cell transplantation (SCT), only the last two indicators remained significant: FLT3-ITD mutation (hazard ratio [HR]=4.6, p<0.001) and SCT (HR=0.43, p=0.01).

Conclusion: In our analysis, there were no significant differences between the chosen regimens. High rates of early toxicity were found, emphasizing the role of supportive care and judicious selection of patients who are eligible for intensive salvage therapy in this setting. The FLT3-ITD mutation and SCT remained significant factors for survival in our study, in line with the results of previous studies.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
Overall survival curve for the total cohort (n=60).
Figure 2
Figure 2
Comparison of overall survival curves according to regimens (top left), age (top right), SCT execution (bottom left), and FLT3 status (bottom right).
None
See this image and copyright information in PMC

References

    1. British Committee for Standards in Haematology. Milligan DW, Grimwade D, Cullis JO, Bond L, Swirsky D, et al. Guidelines on the management of acute myeloid leukaemia in adults. Br J Haematol. 2006;135((4)):450–74. doi: 10.1111/j.1365-2141.2006.06314. - DOI - PubMed
    1. Pulte D, Jansen L, Castro FA, Krilaviciute A, Katalinic A, Barnes B, et al. Survival in patients with acute myeloblastic leukemia in Germany and the United States: Major differences in survival in young adults. Int J Cancer. 2016;139((6)):1289–96. doi: 10.1002/ijc.30186. - DOI - PubMed
    1. Shallis RM, Wang R, Davidoff A, Ma X, Zeidan AM. Epidemiology of acute myeloid leukemia: Recent progress and enduring challenges. Blood Rev. 2019;36:70–87. doi: 10.1016/j.blre.2019.04.005. - DOI - PubMed
    1. Song X, Peng Y, Wang X, Chen Y, Jin L, Yang T, et al. Incidence, Survival, and Risk Factors for Adults with Acute Myeloid Leukemia Not Otherwise Specified and Acute Myeloid Leukemia with Recurrent Genetic Abnormalities: Analysis of the Surveillance, Epidemiology, and End Results (SEER) Database, 2001-2013. Acta Haematol. 2018;139((2)):115–27. doi: 10.1159/000486228. - DOI - PubMed
    1. Benicio MTL, Ribeiro AFT, Américo AD, Furtado FM, Glória AB, Lima AS, et al. Evaluation of the European LeukemiaNet recommendations for predicting outcomes of patients with acute myeloid leukemia treated in low- and middle-income countries (LMIC): A Brazilian experience. Leuk Res. 2017;60:109–14. doi: 10.1016/j.leukres.2017.07.005. - DOI - PubMed