title: Prognostic impact of day 15 blast clearance in risk-adapted remission induction chemotherapy for younger patients with acute myeloid leukemia: long-term results of the multicenter prospective LAM-2001 trial by the GOELAMS study group.
abstract: Early response to chemotherapy has a major prognostic impact in acute myeloid leukemia patients treated with a double induction strategy. Less is known about patients treated with standard-dose cytarabine and anthracycline. We designed a risk-adapted remission induction regimen in which a second course of intermediate-dose cytarabine was delivered after standard "7+3" only if patients had 5% or more bone marrow blasts 15 days after chemotherapy initiation (d15-blasts). Of 823 included patients, 795 (96.6%) were evaluable. Five hundred and forty-five patients (68.6%) had less than 5% d15-blasts. Predictive factors for high d15-blasts were white blood cell count (P<0.0001) and cytogenetic risk (P<0.0001). Patients with fewer than 5% d15-blasts had a higher complete response rate (91.7% vs. 69.2%; P<0.0001) and a lower induction death rate (1.8% vs. 6.8%; P=0.001). Five-year event-free (48.4% vs. 25%; P<0.0001), relapse-free (52.7% vs. 36.9%; P=0.0016) and overall survival (55.3% vs. 36.5%; P<0.0001) were significantly higher in patients with d15-blasts lower than 5%. Multivariate analyses identified d15-blasts and cytogenetic risk as independent prognostic factors for the three end points. Failure to achieve early blast clearance remains a poor prognostic factor even after early salvage. By contrast, early responding patients have a favorable outcome without any additional induction course. (ClinicalTrials.gov identifier NCT01015196).
authors: recher.c@chu-toulouse.fr.
authors: Sarah
authors: S
authors: Bertoli
authors: Pierre
authors: P
authors: Bories
authors: Marie C
authors: MC
authors: Béné
authors: Sylvie
authors: S
authors: Daliphard
authors: Bruno
authors: B
authors: Lioure
authors: Arnaud
authors: A
authors: Pigneux
authors: Norbert
authors: N
authors: Vey
authors: Jacques
authors: J
authors: Delaunay
authors: Vincent
authors: V
authors: Leymarie
authors: Isabelle
authors: I
authors: Luquet
authors: Odile
authors: O
authors: Blanchet
authors: Pascale
authors: P
authors: Cornillet-Lefebvre
authors: Mathilde
authors: M
authors: Hunault
authors: Didier
authors: D
authors: Bouscary
authors: Nathalie
authors: N
authors: Fegueux
authors: Philippe
authors: P
authors: Guardiola
authors: François
authors: F
authors: Dreyfus
authors: Jean Luc
authors: JL
authors: Harousseau
authors: Jean Yves
authors: JY
authors: Cahn
authors: Norbert
authors: N
authors: Ifrah
authors: Christian
authors: C
authors: Récher
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001853:Bone Marrow / Q000473:pathology*; D002869:Chromosome Aberrations; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D013997:Time Factors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
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