Prognostic factors and outcomes of adult patients with acute myeloid leukemia after first relapse.
BACKGROUND
Patients with acute myeloid leukemia who are treated with conventional chemotherapy still have a substantial risk of relapse; the prognostic factors and optimal treatments after relapse have not been fully established. We, therefore, retrospectively analyzed data from patients with acute myeloid leukemia who had achieved first complete remission to assess their prognosis after first relapse.


METHODS
Clinical data were collected from 70 institutions across the country on adult patients who were diagnosed with acute myeloid leukemia and who had achieved a first complete remission after one or two courses of induction chemotherapy.


RESULTS
Among the 1,535 patients who were treated with chemotherapy alone, 1,015 relapsed. Half of them subsequently achieved a second complete remission. The overall survival was 30% at 3 years after relapse. Multivariate analysis showed that achievement of second complete remission, salvage allogeneic hematopoietic cell transplantation, and a relapse-free interval of 1 year or longer were independent prognostic factors. The outcome after allogeneic transplantation in second complete remission was comparable to that after transplantation in first complete remission. Patients with acute myeloid leukemia and cytogenetic risk factors other than inv(16) or t(8;21) had a significantly worse outcome when they did not undergo salvage transplantation even when they achieved second complete remission.


CONCLUSIONS
We found that both the achievement of second complete remission and the application of salvage transplantation were crucial for improving the prognosis of patients with acute myeloid leukemia in first relapse. Our results indicate that the optimal treatment strategy after first relapse may differ according to the cytogenetic risk.
Kurosawa
Saiko
S
Stem Cell Transplantation Division, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan.
Yamaguchi
Takuhiro
T
Miyawaki
Shuichi
S
Uchida
Naoyuki
N
Sakura
Toru
T
Kanamori
Heiwa
H
Usuki
Kensuke
K
Yamashita
Takuya
T
Okoshi
Yasushi
Y
Shibayama
Hirohiko
H
Nakamae
Hirohisa
H
Mawatari
Momoko
M
Hatanaka
Kazuo
K
Sunami
Kazutaka
K
Shimoyama
Manabu
M
Fujishima
Naohito
N
Maeda
Yoshinobu
Y
Miura
Ikuo
I
Takaue
Yoichi
Y
Fukuda
Takahiro
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D007446:Chromosome Inversion / Q000235:genetics; D002877:Chromosomes, Human / Q000235:genetics; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000235:genetics / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014178:Translocation, Genetic / Q000235:genetics; D014184:Transplantation, Homologous