title: Declining rates of treatment-related mortality in patients with newly diagnosed AML given 'intense' induction regimens: a report from SWOG and MD Anderson.
abstract: Less-intense remission induction regimens for adults with newly diagnosed acute myeloid leukemia (AML) aim to reduce treatment-related mortality (TRM), here defined as death within 4 weeks after starting induction therapy. This assumes that TRM rates are similar to the 15-20% observed 20 years ago. Herein we test this assumption. We examined TRM rates in 1409 patients treated on SWOG (Southwest Oncology Group) trials and 1942 patients treated at MD Anderson (MDA) from 1991 to 2009. Eighty-eight percent of SWOG patients received '3+7' or regimens of similar intensity while 92% of the MDA patients received ara-C at 1.5-2.0 g/m(2) daily × 3-5 days+other cytotoxic agents. We examined the relationship between time and TRM rates after accounting for other covariates. TRM rates between 1991 and 2009 decreased from 18-3% in SWOG and 16-4% at MDA. Multivariate analyses showed a significant decrease in TRM over time (P=0.001). The decrease in TRM was not limited to younger patients, those with a better performance status or a lower white blood cell count. Though our observations are limited to patients treated with intensive therapy at SWOG institutions and MDA, the decrease in TRM with time emphasizes the problem with historical controls and could be considered when selecting AML induction therapy.
authors.affiliation: Public Health Sciences Division's Biostatistics and Biomathematics Group, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Othus
authors.affiliation: MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: H
authors.initials: H
authors.lastname: Kantarjian
authors.affiliation: Public Health Sciences Division's Biostatistics and Biomathematics Group, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Petersdorf
authors.affiliation: MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: F
authors.initials: F
authors.lastname: Ravandi
authors.affiliation: Hematology and Oncology Division, Southern Illinois University, Springfield, IL, USA.
authors.forename: J
authors.initials: J
authors.lastname: Godwin
authors.affiliation: MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: J
authors.initials: J
authors.lastname: Cortes
authors.affiliation: MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: S
authors.initials: S
authors.lastname: Pierce
authors.affiliation: Hematologic Malignancy Program, University of Alabama, Birmingham, AL, USA.
authors.forename: H
authors.initials: H
authors.lastname: Erba
authors.affiliation: MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: S
authors.initials: S
authors.lastname: Faderl
authors.affiliation: Public Health Sciences Division's Biostatistics and Biomathematics Group, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA.
authors.forename: F R
authors.initials: FR
authors.lastname: Appelbaum
authors.affiliation: Public Health Sciences Division's Biostatistics and Biomathematics Group, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Estey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult