BACKGROUND: Acute Myeloid Leukemia (AML) is a very aggressive cancer with difficult treatment and poor outcomes. The treatment of these patients is quite challenging due to various reasons including the need for extensive supportive care, and high cost of therapy. Reports on outcomes from India are few. METHODS: We analyzed 93 adult patients (≥ 18 years) with AML who were treated with curative intent between 2007 and 2014. Patients received daunorubicin at dose of 60-90 mg/m2 and cytarabine 100 mg/m2 during induction and consolidation with 3 courses of high dose cytarabine (1.5-3 g/m2per dose for 6 doses per cycle). Only 4 patients underwent consolidation allogenic stem cell transplantation in first remission (CR1). RESULTS: The median age was 37 (18-66) years; males: 52%. Conventional cytogenetics (N = 63) showed 23% (N = 15), 56% (N = 35), 27% (N = 13) in good, intermediate risk and poor risk category respectively. FLT3-ITD was positive in 12/33 (36%) and NPM mutation in 7/23 (30%). Daunorubicin dose was 60 mg/m2 in 75% (N = 70) and 90 mg/m2 in 25% (N = 23) patients. Induction mortality was 17% (16/93) [60 mg/m2:19% (13/70), and 90 mg/m2:13% (3/23); p = 0.39)]. Complete remission was achieved by 60% (56/93) [60 mg/m2:53% (37/70), and 90 mg/m2:83% (19/23); p = 0.09)]. The median overall survival was 9.2 months and the actuarial survival at 2 years was 30%. By univariate analysis, FLT3-ITD positivity, white cell counts higher than 100,000/mm3 at presentation, and use of lower dose of daunorubicin in induction were associated with poorer outcomes. CONCLUSIONS: Outcomes in adult AML are generally poor. Many patients with high risk disease don't receive allogenic transplantation in CR1. Increased availability of allogenic stem cell transplantation may help to improve outcomes.
BACKGROUND:Acute Myeloid Leukemia (AML) is a very aggressive cancer with difficult treatment and poor outcomes. The treatment of these patients is quite challenging due to various reasons including the need for extensive supportive care, and high cost of therapy. Reports on outcomes from India are few. METHODS: We analyzed 93 adult patients (≥ 18 years) with AML who were treated with curative intent between 2007 and 2014. Patients received daunorubicin at dose of 60-90 mg/m2 and cytarabine 100 mg/m2 during induction and consolidation with 3 courses of high dose cytarabine (1.5-3 g/m2per dose for 6 doses per cycle). Only 4 patients underwent consolidation allogenic stem cell transplantation in first remission (CR1). RESULTS: The median age was 37 (18-66) years; males: 52%. Conventional cytogenetics (N = 63) showed 23% (N = 15), 56% (N = 35), 27% (N = 13) in good, intermediate risk and poor risk category respectively. FLT3-ITD was positive in 12/33 (36%) and NPM mutation in 7/23 (30%). Daunorubicin dose was 60 mg/m2 in 75% (N = 70) and 90 mg/m2 in 25% (N = 23) patients. Induction mortality was 17% (16/93) [60 mg/m2:19% (13/70), and 90 mg/m2:13% (3/23); p = 0.39)]. Complete remission was achieved by 60% (56/93) [60 mg/m2:53% (37/70), and 90 mg/m2:83% (19/23); p = 0.09)]. The median overall survival was 9.2 months and the actuarial survival at 2 years was 30%. By univariate analysis, FLT3-ITD positivity, white cell counts higher than 100,000/mm3 at presentation, and use of lower dose of daunorubicin in induction were associated with poorer outcomes. CONCLUSIONS: Outcomes in adult AML are generally poor. Many patients with high risk disease don't receive allogenic transplantation in CR1. Increased availability of allogenic stem cell transplantation may help to improve outcomes.
Authors: Markus Schaich; Christoph Röllig; Silke Soucek; Michael Kramer; Christian Thiede; Brigitte Mohr; Uta Oelschlaegel; Norbert Schmitz; Reingard Stuhlmann; Hannes Wandt; Kerstin Schäfer-Eckart; Walter Aulitzky; Martin Kaufmann; Heinrich Bodenstein; Joachim Tischler; Anthony Ho; Alwin Krämer; Martin Bornhäuser; Johannes Schetelig; Gerhard Ehninger Journal: J Clin Oncol Date: 2011-05-23 Impact factor: 44.544
Authors: Bob Löwenberg; Thomas Pabst; Edo Vellenga; Wim van Putten; Harry C Schouten; Carlos Graux; Augustin Ferrant; Pieter Sonneveld; Bart J Biemond; Alois Gratwohl; Georgine E de Greef; Leo F Verdonck; Martijn R Schaafsma; Michael Gregor; Matthias Theobald; Urs Schanz; Johan Maertens; Gert J Ossenkoppele Journal: N Engl J Med Date: 2011-03-17 Impact factor: 91.245
Authors: Hugo F Fernandez; Zhuoxin Sun; Xiaopan Yao; Mark R Litzow; Selina M Luger; Elisabeth M Paietta; Janis Racevskis; Gordon W Dewald; Rhett P Ketterling; John M Bennett; Jacob M Rowe; Hillard M Lazarus; Martin S Tallman Journal: N Engl J Med Date: 2009-09-24 Impact factor: 91.245
Authors: Hartmut Döhner; Elihu H Estey; Sergio Amadori; Frederick R Appelbaum; Thomas Büchner; Alan K Burnett; Hervé Dombret; Pierre Fenaux; David Grimwade; Richard A Larson; Francesco Lo-Coco; Tomoki Naoe; Dietger Niederwieser; Gert J Ossenkoppele; Miguel A Sanz; Jorge Sierra; Martin S Tallman; Bob Löwenberg; Clara D Bloomfield Journal: Blood Date: 2009-10-30 Impact factor: 22.113
Authors: Alan K Burnett; Nigel H Russell; Robert K Hills; Ann E Hunter; Lars Kjeldsen; John Yin; Brenda E S Gibson; Keith Wheatley; Donald Milligan Journal: J Clin Oncol Date: 2013-08-12 Impact factor: 44.544