title: Outcomes of patients who undergo aggressive induction therapy for secondary acute myeloid leukemia.
abstract: BACKGROUND
  Response and survival in 96 patients with secondary acute myeloid leukemia (sAML) who received aggressive induction chemotherapy was reviewed.
  
  
  METHODS
  The median follow-up of survivors was 2.3 years. A total of 70 (73%) patients achieved a morphologic complete remission (CR) confirmed by absence of leukemic blasts by flow cytometry.
  
  
  RESULTS
  For all 96 patients, the median event-free survival (EFS) was 8 months, and overall survival (OS) was 13.6 months (range, 1-119 months). Eight patients died shortly after induction therapy because of disease or side effects, and 13 are currently in continuous first remission. The median disease-free survival (DFS) for all 70 patients who achieved a morphologic CR was 9 months (range, 1-51 months), with a 64% chance of surviving 1 year. Patients with AML after previous chemotherapy or radiation therapy had a higher morphologic remission rate compared with those arising from myelodysplastic syndrome or myeloproliferative disease (82% vs 62%; P = .027). However, among the patients from the 2 groups who attained a morphologic remission, there was no difference in terms of CR rate (P = .94), DFS, EFS, or OS (P = .55, .83, and .71, respectively). This is a similar DFS to the group of 7 patients who went directly to ablative allogeneic transplant rather than having induction therapy first. In this population of patients who received aggressive chemotherapy, Charlson comorbidity index or a higher number of factors recognized as high risk in leukemia patients did not affect the chance of OS, DFS, and EFS, although having more recognized leukemia risk factors was related to a lower chance of surviving 1 year. However, it is important to note that those with higher comorbidity indexes were underrepresented in this aggressively treated cohort.
  
  
  CONCLUSIONS
  The data from the current study demonstrate that many patients with sAML can tolerate aggressive induction therapy and attain remission, but duration of response and the chance of long-term survival remain poor.
authors.affiliation: Department of Medicine, Division of Cellular Therapy, Duke University Medical Center, Durham, North Carolina 27710, USA. rizzi003@mc.duke.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Rizzieri
authors.forename: Jenny A
authors.initials: JA
authors.lastname: O'Brien
authors.forename: Gloria
authors.initials: G
authors.lastname: Broadwater
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Decastro
authors.forename: Prakash
authors.initials: P
authors.lastname: Dev
authors.forename: Louis
authors.initials: L
authors.lastname: Diehl
authors.forename: Anne
authors.initials: A
authors.lastname: Beaven
authors.forename: Anand
authors.initials: A
authors.lastname: Lagoo
authors.forename: Jon P
authors.initials: JP
authors.lastname: Gockerman
authors.forename: Nelson J
authors.initials: NJ
authors.lastname: Chao
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Moore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000188:drug therapy*; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis