Outcome of high-dose cytarabine-based induction therapy followed by hematopoietic stem cell transplantation in acute myeloid leukemia: influence of karyotype.
One-hundred-twenty consecutive adult patients aged 15-69 years (median 40) with acute myeloid leukemia (AML) excluding t(15;17) received induction therapy comprising idarubicin, high-dose cytarabine and etoposide. Planned post-induction treatment included two courses of moderate-intensity consolidation therapy followed by stem cell transplantation. 11 patients (9%) died during induction therapy. The complete remission (CR) rate with a single cycle of induction therapy was 71%. The overall CR rate, after salvage chemotherapy but excluding allogeneic transplantation for primary refractory disease, was 82%. CR rates with one cycle of therapy for patients with good, intermediate and poor karyotype were 96, 72 and 41%, respectively (P<0.0001). The impact of karyotype on the overall CR rate was also significant (96 vs. 88 vs. 59%; P=0.001). Overall, 84 of 98 patients (86%) attaining CR underwent autologous (n=59), allogeneic (n=23) or syngeneic (n=2) hematopoietic stem cell transplantation in first CR. The 5-year overall survival (OS) of 43% (95% CI: 34-52%) was significantly influenced by the karyotype: good 73%, intermediate 41%, and poor 18% (P=0.0001). These data suggest that the sequence of therapy employed is active in AML, but additional steps are needed to improve the outcome of patients with intermediate- and high-risk cytogenetic abnormalities.
Sirohi
Bhawna
B
The Royal Marsden Hospital, Surrey, UK.
Powles
Ray
R
Singhal
Seema
S
Smith
Katy
K
Jones
Robin L
RL
Saso
Radovan
R
Kulkarni
Samar
S
Treleaven
Jennifer
J
Swansbury
G John
GJ
Potter
Mike
M
Morgan
Gareth
G
Mehta
Jayesh
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002869:Chromosome Aberrations; D003561:Cytarabine / Q000008:administration & dosage*; D005047:Etoposide; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015255:Idarubicin; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000235:genetics* / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D012074:Remission Induction / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome
D003561:Cytarabine; D005047:Etoposide; D015255:Idarubicin