title: Multicentre survey to explore current survival of patients with acute myeloid leukaemia who failed induction chemotherapy.
abstract: BACKGROUND
  Acute myeloid leukaemia not responsive to first induction chemotherapy (PIF-AML) still remains a challenge, and there are only few recent epidemiological data regarding the outcome of these patients. In this multicentre survey, we evaluate the prognosis and outcome of patients with PIF-AML, who were diagnosed and treated in the last 5 yrs in four Italian institutions.
  
  
  RESULTS
  One hundred PIF-AML were recorded, 57 males and 43 females, with a median age of 63 yrs (19-79), 42% were younger than 60 yrs; 42% had a secondary AML and 40% had an adverse karyotype. According to cytogenetic/molecular risk stratification at diagnosis, 33% of patients were classified as favourable/intermediate-1 risk and 56% as intermediate-2/adverse risk. After a median follow-up of 11 months (1-49), 77% of patients died, while 23% were alive (with 12/23 in cCR). Thirty-six patients underwent allogeneic SCT, and of these, 11 of 36 (31%) were alive at last follow-up. The 12- and 24-month OS probability of the whole population was 45% and 21%, respectively. In multivariate analysis, the probability of OS of the whole population was significantly improved by Allo-SCT procedure (12-month OS probability 60% vs. 35%; P < 0.0001) and was better in patients with favourable/intermediate-1 risk at diagnosis (12-month OS probability 58% vs. 40%; P = 0.028). In transplanted cases, a pretransplant responsive disease was the only significant factor to predict a favourable outcome after Allo-SCT (P = 0.006).
  
  
  CONCLUSIONS
  Treatment options of PIF-AML still are limited and the prognosis, even recently, remains extremely poor. This survey shows that PIF-AML is still rarely cured without Allo-SCT and confirms the importance of initiating an urgent unrelated donor search in cases without a matched sibling donor. Moreover, the outcome of Allo-SCT is better in patients who achieve a good AML debulking before transplant. To reach this goal, new predictive scores and new protocols of salvage therapy (with target drugs or combinations) need to be explored urgently in PIF-AML.
authors.affiliation: Division of Hematology and SCT, University Hospital of Udine, Udine, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzarotto
authors.affiliation: Division of Hematology and SCT, University Hospital of Udine, Udine, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Candoni
authors.affiliation: Division of Hematology, University of Verona, Verona, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Nadali
authors.affiliation: Division of Hematology, University of Padua, Padua, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pavan
authors.affiliation: Division of Hematology, University of Padua, Padua, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Lessi
authors.affiliation: Division of Hematology, Hospital of Treviso, Treviso, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Mosna
authors.affiliation: Division of Hematology and SCT, University Hospital of Udine, Udine, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Simeone
authors.affiliation: Division of Hematology and SCT, University Hospital of Udine, Udine, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Ventura
authors.affiliation: Division of Hematology, Hospital of Treviso, Treviso, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Gherlinzoni
authors.affiliation: Division of Hematology, University of Padua, Padua, Italy.
authors.forename: Gianpietro
authors.initials: G
authors.lastname: Semenzato
authors.affiliation: Division of Hematology, University of Verona, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pizzolo
authors.affiliation: Division of Hematology and SCT, University Hospital of Udine, Udine, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Fanin
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D019008:Drug Resistance, Neoplasm; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D060828:Induction Chemotherapy; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D017211:Treatment Failure; D055815:Young Adult
keywords: acute myeloid leukaemia; primary induction failure