title: Prognostic factors and outcomes of adult patients with acute myeloid leukemia after first relapse.
abstract: 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.
authors.affiliation: Stem Cell Transplantation Division, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan.
authors.forename: Saiko
authors.initials: S
authors.lastname: Kurosawa
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Shuichi
authors.initials: S
authors.lastname: Miyawaki
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Uchida
authors.forename: Toru
authors.initials: T
authors.lastname: Sakura
authors.forename: Heiwa
authors.initials: H
authors.lastname: Kanamori
authors.forename: Kensuke
authors.initials: K
authors.lastname: Usuki
authors.forename: Takuya
authors.initials: T
authors.lastname: Yamashita
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okoshi
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Shibayama
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Nakamae
authors.forename: Momoko
authors.initials: M
authors.lastname: Mawatari
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hatanaka
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Sunami
authors.forename: Manabu
authors.initials: M
authors.lastname: Shimoyama
authors.forename: Naohito
authors.initials: N
authors.lastname: Fujishima
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Maeda
authors.forename: Ikuo
authors.initials: I
authors.lastname: Miura
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takaue
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fukuda
mesh_terms: 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