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

Research output: Contribution to journalArticle

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
Externally publishedYes

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Induction Chemotherapy
Chemotherapy
Cytarabine
Acute Myeloid Leukemia
Refractory materials
Salvaging
Stem cells
Stem Cell Transplantation
Anthracyclines
Cytogenetics
Platelets
Blood
Cells
Recovery
Leukocytosis
Leukocyte Count
Thrombocytopenia
Blood Platelets
Multivariate Analysis
Bone Marrow

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Characteristics and outcome of patients with acute myeloid leukemia refractory to 1 cycle of high-dose cytarabine-based induction chemotherapy. / Ravandi, Farhad; Cortes, Jorge; Faderl, Stefan; O'Brien, Susan; Garcia-Manero, Guillermo; Verstovsek, Srdan; Santos, Fabio P.S.; Shan, Jianqin; Brandt, Mark; De Lima, Marcos; Pierce, Sherry; Kantarjian, Hagop.

In: Blood, Vol. 116, No. 26, 23.12.2010, p. 5818-5823.

Research output: Contribution to journalArticle

Ravandi, F, Cortes, J, Faderl, S, O'Brien, S, Garcia-Manero, G, Verstovsek, S, Santos, FPS, 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, vol. 116, no. 26, pp. 5818-5823. https://doi.org/10.1182/blood-2010-07-296392
Ravandi, Farhad ; Cortes, Jorge ; Faderl, Stefan ; O'Brien, Susan ; Garcia-Manero, Guillermo ; Verstovsek, Srdan ; Santos, Fabio P.S. ; Shan, Jianqin ; Brandt, Mark ; De Lima, Marcos ; Pierce, Sherry ; Kantarjian, Hagop. / Characteristics and outcome of patients with acute myeloid leukemia refractory to 1 cycle of high-dose cytarabine-based induction chemotherapy. In: Blood. 2010 ; Vol. 116, No. 26. pp. 5818-5823.
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