Improving outcomes for patients with acute myeloid leukemia in first relapse: A single center experience

The outcome of patients with relapsed acute myeloid leukemia (AML) remains unsatisfactory, with few available effective therapies. Increased understanding of the biology of the disease has led to the identification of novel therapeutic agents, several of which have been evaluated in recently conducted clinical trials. We sought to determine whether the introduction of these agents as well as modern supportive care measures has already translated to better outcomes. We examined the outcomes of 1,056 patients with AML in first relapse treated between January 1993 and December 2013 at our institution. As previously reported, the independent prognostic factors for survival after first relapse included age at relapse, cytogenetics, and duration of first complete remission. Upon multivariable analysis, treatment era was an independent predictor of survival, with significant improvement in overall survival between 2008 and 2013 as compared to prior time periods. Modern supportive care measures as well as participation in clinical trials of novel agents are already improving the outcomes in first relapse. Am. J. Hematol. 90:27–30, 2015. © 2014 Wiley Periodicals, Inc.

[1]  M. Andreeff,et al.  Investigational FMS-like tyrosine kinase 3 inhibitors in treatment of acute myeloid leukemia , 2014, Expert opinion on investigational drugs.

[2]  M. Levis,et al.  FLT3 tyrosine kinase inhibitors in acute myeloid leukemia: clinical implications and limitations , 2014, Leukemia & lymphoma.

[3]  Jorge Cortes,et al.  Phase 2 study of azacytidine plus sorafenib in patients with acute myeloid leukemia and FLT-3 internal tandem duplication mutation. , 2013, Blood.

[4]  Z. Estrov,et al.  Salvage therapy using FLT3 inhibitors may improve long‐term outcome of relapsed or refractory AML in patients with FLT3‐ITD , 2013, British journal of haematology.

[5]  H. Kantarjian,et al.  Epigenetic therapy is associated with similar survival compared with intensive chemotherapy in older patients with newly diagnosed acute myeloid leukemia. , 2012, Blood.

[6]  N. Socci,et al.  Prognostic relevance of integrated genetic profiling in acute myeloid leukemia. , 2012, The New England journal of medicine.

[7]  B. Löwenberg,et al.  Therapeutic advances in acute myeloid leukemia. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[8]  M. Shimoyama,et al.  Prognostic factors and outcomes of adult patients with acute myeloid leukemia after first relapse , 2010, Haematologica.

[9]  C. Bloomfield,et al.  Clinical response and miR-29b predictive significance in older AML patients treated with a 10-day schedule of decitabine , 2010, Proceedings of the National Academy of Sciences.

[10]  G. Mufti,et al.  Prolonged survival with improved tolerability in higher‐risk myelodysplastic syndromes: azacitidine compared with low dose ara‐C , 2010, British journal of haematology.

[11]  H. Dombret,et al.  Azacitidine prolongs overall survival compared with conventional care regimens in elderly patients with low bone marrow blast count acute myeloid leukemia. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  H. Kantarjian,et al.  Characteristics and outcome of patients with acute myeloid leukemia refractory to 1 cycle of high-dose cytarabine-based induction chemotherapy. , 2009, Blood.

[13]  Valeria Santini,et al.  Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomised, open-label, phase III study. , 2009, The Lancet. Oncology.

[14]  M. Grever,et al.  Phase I study of decitabine alone or in combination with valproic acid in acute myeloid leukemia. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  John M Bennett,et al.  Decitabine improves patient outcomes in myelodysplastic syndromes , 2006, Cancer.

[16]  Bob Löwenberg,et al.  Prognostic index for adult patients with acute myeloid leukemia in first relapse. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[17]  W. Hiddemann,et al.  Superiority of high-dose over intermediate-dose cytosine arabinoside in the treatment of patients with high-risk acute myeloid leukemia: results of an age-adjusted prospective randomized comparison , 1998, Leukemia.

[18]  H. Kantarjian,et al.  A stratification system for evaluating and selecting therapies in patients with relapsed or primary refractory acute myelogenous leukemia. , 1996, Blood.

[19]  D. Niederwieser,et al.  Treatment of relapsed and refractory acute myelogenous leukaemia with aclacinomycin A (ACA) and etoposide (VP-16). , 1994, Leukemia research : a Forum for Studies on Leukemia and Normal Hemopoiesis.

[20]  E. Estey,et al.  Response to salvage therapy and survival after relapse in acute myelogenous leukemia. , 1989, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.