title: Allogeneic stem cell transplantation as initial salvage for patients with acute myeloid leukemia refractory to high-dose cytarabine-based induction chemotherapy.
abstract: Outcomes of patients with acute myeloid leukemia (AML) who are refractory to high-dose Cytarabine (HiDAC)-based induction are dismal. Allogeneic hematopoietic stem cell transplantation (AHSCT) as initial salvage may be effective and potentially superior to conventional salvage chemotherapy. Eighteen percent (285 of 1597) of AML patients were primary refractory to HiDAC-based regimens at the MD Anderson Cancer Center between 1995 and 2009. AHSCT was the initial salvage in 28 cases. These patients were compared against 149 patients who received salvage chemotherapy, but never received AHSCT. Patients receiving salvage chemotherapy were older, had higher bone marrow blasts percentage, and higher incidence of unfavorable cytogenetics (P < 0.001). Median time from induction to AHSCT was 76 days. Objective response was achieved in 23 of 28 patients (82%) undergoing AHSCT. The incidence of grade III/IV acute and chronic graft versus-host-disease was 11% and 29%, respectively. Median follow up for living patients is 80 months. Median overall survival (OS) was 15.7 months and 2.9 months for AHSCT and chemotherapy, respectively (P < 0.001); the 3-year OS rates were 39% and 2%, respectively. ASHCT as initial salvage therapy was identified as an independent prognostic factor for survival in multivariate analysis (HR = 3.03; P < 0.001). Initial salvage therapy with AHSCT in patients with primary HiDAC refractory AML is feasible and may yield superior outcomes to salvage chemotherapy.
authors.affiliation: Department of Leukemia, U.T. M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Elias
authors.initials: E
authors.lastname: Jabbour
authors.forename: Naval
authors.initials: N
authors.lastname: Daver
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
authors.forename: Michael
authors.initials: M
authors.lastname: Mathisen
authors.forename: Betul
authors.initials: B
authors.lastname: Oran
authors.forename: Stefan
authors.initials: S
authors.lastname: Ciurea
authors.forename: Issa
authors.initials: I
authors.lastname: Khouri
authors.forename: A Megan
authors.initials: AM
authors.lastname: Cornelison
authors.forename: Hady
authors.initials: H
authors.lastname: Ghanem
authors.forename: Marylou
authors.initials: M
authors.lastname: Cardenas-Turanzas
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
authors.forename: Farhad
authors.initials: F
authors.lastname: Ravandi
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Guillermo
authors.initials: G
authors.lastname: Garcia-Manero
authors.forename: Jorge
authors.initials: J
authors.lastname: Cortes
authors.forename: Hagop
authors.initials: H
authors.lastname: Kantarjian
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology; D003561:Cytarabine / Q000008:administration & dosage / Q000494:pharmacology*; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D014411:Neoplastic Stem Cells / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003561:Cytarabine