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. 2020 Aug 25;10(4):124-133.
eCollection 2020.

Outcomes of patients with relapsed or refractory acute myeloid leukemia: a population-based real-world study

Joseph M Brandwein  1 , Lalit Saini  2 , Michelle N Geddes  3 , Dimas Yusuf  4 , Fei Liu  5 , Kiersten Schwann  1 , Alkarim Billawala  3 , Christopher Westcott  6 , Jessica A Kurniawan  4 , Winson Y Cheung  3
Affiliations

Outcomes of patients with relapsed or refractory acute myeloid leukemia: a population-based real-world study

Joseph M Brandwein et al. Am J Blood Res. .

Abstract

With standard therapies for patients with acute myeloid leukemia (AML), many patients either do not achieve complete response (CR) or relapse after CR. There are a scarcity of real-world data on outcomes of unselected patients with relapsed/refractory acute myeloid leukemia (RR-AML). We retrospectively evaluated treatment patterns and survival outcomes of unselected patients aged ≥18 years diagnosed with RR-AML identified from the Alberta Cancer Registry, Alberta, Canada, between January 2013 and December 2016. We included 199 patients who met predefined criteria for RR-AML. Following RR-AML diagnosis, 23% of patients received intensive therapy (IT), 33% non-intensive therapy (NIT), and 44% best supportive care (BSC). The unadjusted median overall survival (OS) of the study cohort was 5.3 months from the time of RR-AML diagnosis, with a 5-year OS rate of 12.6% (95% confidence interval 7.5-21.1). According to treatment intensity after RR-AML, the median OS outcomes were 13.6, 9.4, and 2.0 months for IT, NIT, and BSC groups, respectively (P<0.001). Patients who received treatment (IT or NIT) had better survival than those who received only BSC. This study emphasizes the need for newer therapy options for patients with RR-AML.

Keywords: Acute myeloid leukemia; overall survival; real-world data; refractory; registry; relapsed.

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Conflict of interest statement

JMB has received honoraria from Bristol Myers Squibb, Novartis, Otsuka, Pfizer, Jazz Pharmaceuticals and Teva. MNG has received honoraria from Bristol Myers Squibb, Novartis, Otsuka, Pfizer, Jazz Pharmaceuticals. DY has received honoraria from Bristol Myers Squibb to conduct this study. FFL is an employee of Bristol Myers Squibb. CW is an employee of Celgene Inc., a Bristol Myers Squibb company. WYC has received research funding and consulting fees from Bristol Myers Squibb. The remaining authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
OS (A) of the entire cohort and (B) according to treatment intensity post-RR-AML. BSC: best supportive care; CI: confidence interval; IT: intensive therapy; NIT: non-intensive therapy; NR: not reached; OS: overall survival; RR-AML: relapsed/refractory acute myeloid leukemia. *P<0.001 between IT, NIT, and BSC groups.
Figure 2
Figure 2
OS (A) according to age at diagnosis and (B) according to ELN risk group. CI: confidence interval; ELN: European LeukemiaNet; NR: not reached; OS: overall survival. *P=0.009 compared with ≥60 years, **P=0.003 between ELN risk groups.
Figure 3
Figure 3
OS for the patients achieving CR post-RR-AML according to whether the patients underwent subsequent alloSCT. alloSCT: allogeneic stem cell transplantation; CI: confidence interval; CR: complete response; NR: not reached; OS: overall survival; RR-AML: relapsed/refractory acute myeloid leukemia. aFour patients who had alloSCT post-RR-AML were excluded because they did not attain CR status, the status was incorrectly entered, or the status was missing.
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