Characteristics and outcome of patients with acute myeloid leukemia refractory to 1 cycle of high-dose cytarabine-based induction chemotherapy

Farhad Ravandi, Jorge Cortes, Stefan Faderl, Susan O'Brien, Guillermo Garcia-Manero, Srdan Verstovsek, Fabio P.S. Santos, Jianqin Shan, Mark Brandt, Marcos De Lima, Sherry Pierce, Hagop Kantarjian

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73 Scopus citations

Abstract

Pretreatment characteristics and outcome of patients treated with induction regimens containing high-dose ara-C (HiDAC) at M. D. Anderson Cancer Center refractory to 1 cycle of induction were compared with similar patients achieving a complete response (CR). Among 1597 patients treated with HiDAC-based induction from 1995 to 2009, 285 were refractory to 1 cycle. Median age was 59 years (range, 18-85 years). Induction regimens included HiDAC with anthracyclines (n = 181; 64%) or HiDAC with nonanthracycline chemotherapy (n = 104; 36%). Refractory patients were older (median age, 59 vs 56 years; P <.001), more likely with unfavorable cytogenetics (P<.001) and antecedent hematologic disorder (P <.001), and had a higher presentation white blood cell count (P =.04), but not a higher incidence of FLT3 mutations (P =.85), than those achieving CR. Forty-three patients (22%) responded to salvage (35 CR and 8 CR without platelet recovery). With a median follow-up of 72 months (range, 27-118 months) in responders, 11 are alive. Nineteen patients (7%) were alive and in CR for at least 6 months, including 9 who underwent allogeneic stem cell transplantation. On multivariate analysis, severe thrombocytopenia, leukocytosis, increasing marrow blast percentage, unfavorable cytogenetics, and salvage not including allogeneic stem cell transplantation were associated with a worse survival. Alternative strategies are needed for these patients.

Original languageEnglish (US)
Pages (from-to)5818-5823
Number of pages6
JournalBlood
Volume116
Issue number26
DOIs
StatePublished - Dec 23 2010

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ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Ravandi, F., Cortes, J., Faderl, S., O'Brien, S., Garcia-Manero, G., Verstovsek, S., Santos, F. P. S., Shan, J., Brandt, M., De Lima, M., Pierce, S., & Kantarjian, H. (2010). Characteristics and outcome of patients with acute myeloid leukemia refractory to 1 cycle of high-dose cytarabine-based induction chemotherapy. Blood, 116(26), 5818-5823. https://doi.org/10.1182/blood-2010-07-296392