Outcome of patients with acute myelogenous leukemia after second salvage therapy

Francis Giles, Susan O'Brien, Jorge Cortes, Srdan Verstovsek, Carlos Bueso-Ramos, Jianqin Shan, Sherry Pierce, Guillermo Garcia-Manero, Michael Keating, Hagop Kantarjian

Research output: Contribution to journalArticle

Abstract

BACKGROUND. Although the prognosis is poor for patients with acute myelogenous leukemia (AML) who have disease recurrence after frontline therapy, this is a general reflection of first salvage therapies. The outcome of patients undergoing second salvage therapy in relation to complete response (CR) rates and survival has not been documented. The authors analyzed the outcome of patients with AML undergoing second salvage therapy, and identified prognostic factors associated with response and survival. METHODS. The records of 594 patients with AML undergoing second salvage therapy from 1980 until 2004 were reviewed. The patient median age was 50 years. Salvage therapy included allogeneic stem cell transplantation (SCT) in 74 patients, standard-dose cytosine arabinoside (ara-C) combinations in 30 patients, high-dose ara-C combinations in 171 patients, non-ara-C combinations in 73 patients, and Phase I-II single agents in 246 patients. RESULTS. Overall, 76 patients (13%) achieved CR. The median CR duration was 7 months. The median survival was 1.5 months, and the 1-year survival rate was 8%. A multivariate analysis of prognostic factors for CR identified the following 6 independent adverse factors: first CR duration < 6 months; second CR duration < 6 months; salvage therapy not including allogeneic SCT; non-inversion 16 AML; platelet counts < 50 × 109/L, and leukocytosis > 50 × 109/L. Patients were divided into low-risk (1-2 adverse factors; 8%), intermediate 1 (3 factors; 20%), intermediate 2 (4 factors; 38%), and high-risk groups (5-6 factors; 33%) with respective CR rates of 54%, 26%, 8%, and 0%. The respective 1-year survival rates were 36%, 21%, 6%, and 1%. A multivariate analysis for survival identified the following 7 independent adverse factors: first CR duration < 12 months; second CR duration < 6 months; bilirubin level ≥ 1 mg/dL; albumin level < 3 g/dL; age > 60 years; bone marrow blasts ≥ 50%; and year of therapy before 1991. Patients were divided into low-risk (0-2 adverse factors; 39%), intermediate (3 factors; 27%), and high-risk groups (≥ 4 factors; 34%) with estimated 1-year survival rates of 22%, 6%, and 0%, respectively. The respective CR rates were 26%, 8%, and 2%. CONCLUSIONS. The current analysis established the outcome and prognostic factors associated with second salvage therapy in AML. It also proposed risk models and groups that could be used for comparison of results of present and future investigational strategies.

Original languageEnglish (US)
Pages (from-to)547-554
Number of pages8
JournalCancer
Volume104
Issue number3
DOIs
StatePublished - Aug 1 2005
Externally publishedYes

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Salvage Therapy
Acute Myeloid Leukemia
Cytarabine
Survival Rate
Survival
Multivariate Analysis
Stem Cell Transplantation

Keywords

  • Acute myelogenous leukemia
  • Complete response
  • Cytosine arabinoside
  • Salvage therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Giles, F., O'Brien, S., Cortes, J., Verstovsek, S., Bueso-Ramos, C., Shan, J., ... Kantarjian, H. (2005). Outcome of patients with acute myelogenous leukemia after second salvage therapy. Cancer, 104(3), 547-554. https://doi.org/10.1002/cncr.21187

Outcome of patients with acute myelogenous leukemia after second salvage therapy. / Giles, Francis; O'Brien, Susan; Cortes, Jorge; Verstovsek, Srdan; Bueso-Ramos, Carlos; Shan, Jianqin; Pierce, Sherry; Garcia-Manero, Guillermo; Keating, Michael; Kantarjian, Hagop.

In: Cancer, Vol. 104, No. 3, 01.08.2005, p. 547-554.

Research output: Contribution to journalArticle

Giles, F, O'Brien, S, Cortes, J, Verstovsek, S, Bueso-Ramos, C, Shan, J, Pierce, S, Garcia-Manero, G, Keating, M & Kantarjian, H 2005, 'Outcome of patients with acute myelogenous leukemia after second salvage therapy', Cancer, vol. 104, no. 3, pp. 547-554. https://doi.org/10.1002/cncr.21187
Giles F, O'Brien S, Cortes J, Verstovsek S, Bueso-Ramos C, Shan J et al. Outcome of patients with acute myelogenous leukemia after second salvage therapy. Cancer. 2005 Aug 1;104(3):547-554. https://doi.org/10.1002/cncr.21187
Giles, Francis ; O'Brien, Susan ; Cortes, Jorge ; Verstovsek, Srdan ; Bueso-Ramos, Carlos ; Shan, Jianqin ; Pierce, Sherry ; Garcia-Manero, Guillermo ; Keating, Michael ; Kantarjian, Hagop. / Outcome of patients with acute myelogenous leukemia after second salvage therapy. In: Cancer. 2005 ; Vol. 104, No. 3. pp. 547-554.
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abstract = "BACKGROUND. Although the prognosis is poor for patients with acute myelogenous leukemia (AML) who have disease recurrence after frontline therapy, this is a general reflection of first salvage therapies. The outcome of patients undergoing second salvage therapy in relation to complete response (CR) rates and survival has not been documented. The authors analyzed the outcome of patients with AML undergoing second salvage therapy, and identified prognostic factors associated with response and survival. METHODS. The records of 594 patients with AML undergoing second salvage therapy from 1980 until 2004 were reviewed. The patient median age was 50 years. Salvage therapy included allogeneic stem cell transplantation (SCT) in 74 patients, standard-dose cytosine arabinoside (ara-C) combinations in 30 patients, high-dose ara-C combinations in 171 patients, non-ara-C combinations in 73 patients, and Phase I-II single agents in 246 patients. RESULTS. Overall, 76 patients (13{\%}) achieved CR. The median CR duration was 7 months. The median survival was 1.5 months, and the 1-year survival rate was 8{\%}. A multivariate analysis of prognostic factors for CR identified the following 6 independent adverse factors: first CR duration < 6 months; second CR duration < 6 months; salvage therapy not including allogeneic SCT; non-inversion 16 AML; platelet counts < 50 × 109/L, and leukocytosis > 50 × 109/L. Patients were divided into low-risk (1-2 adverse factors; 8{\%}), intermediate 1 (3 factors; 20{\%}), intermediate 2 (4 factors; 38{\%}), and high-risk groups (5-6 factors; 33{\%}) with respective CR rates of 54{\%}, 26{\%}, 8{\%}, and 0{\%}. The respective 1-year survival rates were 36{\%}, 21{\%}, 6{\%}, and 1{\%}. A multivariate analysis for survival identified the following 7 independent adverse factors: first CR duration < 12 months; second CR duration < 6 months; bilirubin level ≥ 1 mg/dL; albumin level < 3 g/dL; age > 60 years; bone marrow blasts ≥ 50{\%}; and year of therapy before 1991. Patients were divided into low-risk (0-2 adverse factors; 39{\%}), intermediate (3 factors; 27{\%}), and high-risk groups (≥ 4 factors; 34{\%}) with estimated 1-year survival rates of 22{\%}, 6{\%}, and 0{\%}, respectively. The respective CR rates were 26{\%}, 8{\%}, and 2{\%}. CONCLUSIONS. The current analysis established the outcome and prognostic factors associated with second salvage therapy in AML. It also proposed risk models and groups that could be used for comparison of results of present and future investigational strategies.",
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T1 - Outcome of patients with acute myelogenous leukemia after second salvage therapy

AU - Giles, Francis

AU - O'Brien, Susan

AU - Cortes, Jorge

AU - Verstovsek, Srdan

AU - Bueso-Ramos, Carlos

AU - Shan, Jianqin

AU - Pierce, Sherry

AU - Garcia-Manero, Guillermo

AU - Keating, Michael

AU - Kantarjian, Hagop

PY - 2005/8/1

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N2 - BACKGROUND. Although the prognosis is poor for patients with acute myelogenous leukemia (AML) who have disease recurrence after frontline therapy, this is a general reflection of first salvage therapies. The outcome of patients undergoing second salvage therapy in relation to complete response (CR) rates and survival has not been documented. The authors analyzed the outcome of patients with AML undergoing second salvage therapy, and identified prognostic factors associated with response and survival. METHODS. The records of 594 patients with AML undergoing second salvage therapy from 1980 until 2004 were reviewed. The patient median age was 50 years. Salvage therapy included allogeneic stem cell transplantation (SCT) in 74 patients, standard-dose cytosine arabinoside (ara-C) combinations in 30 patients, high-dose ara-C combinations in 171 patients, non-ara-C combinations in 73 patients, and Phase I-II single agents in 246 patients. RESULTS. Overall, 76 patients (13%) achieved CR. The median CR duration was 7 months. The median survival was 1.5 months, and the 1-year survival rate was 8%. A multivariate analysis of prognostic factors for CR identified the following 6 independent adverse factors: first CR duration < 6 months; second CR duration < 6 months; salvage therapy not including allogeneic SCT; non-inversion 16 AML; platelet counts < 50 × 109/L, and leukocytosis > 50 × 109/L. Patients were divided into low-risk (1-2 adverse factors; 8%), intermediate 1 (3 factors; 20%), intermediate 2 (4 factors; 38%), and high-risk groups (5-6 factors; 33%) with respective CR rates of 54%, 26%, 8%, and 0%. The respective 1-year survival rates were 36%, 21%, 6%, and 1%. A multivariate analysis for survival identified the following 7 independent adverse factors: first CR duration < 12 months; second CR duration < 6 months; bilirubin level ≥ 1 mg/dL; albumin level < 3 g/dL; age > 60 years; bone marrow blasts ≥ 50%; and year of therapy before 1991. Patients were divided into low-risk (0-2 adverse factors; 39%), intermediate (3 factors; 27%), and high-risk groups (≥ 4 factors; 34%) with estimated 1-year survival rates of 22%, 6%, and 0%, respectively. The respective CR rates were 26%, 8%, and 2%. CONCLUSIONS. The current analysis established the outcome and prognostic factors associated with second salvage therapy in AML. It also proposed risk models and groups that could be used for comparison of results of present and future investigational strategies.

AB - BACKGROUND. Although the prognosis is poor for patients with acute myelogenous leukemia (AML) who have disease recurrence after frontline therapy, this is a general reflection of first salvage therapies. The outcome of patients undergoing second salvage therapy in relation to complete response (CR) rates and survival has not been documented. The authors analyzed the outcome of patients with AML undergoing second salvage therapy, and identified prognostic factors associated with response and survival. METHODS. The records of 594 patients with AML undergoing second salvage therapy from 1980 until 2004 were reviewed. The patient median age was 50 years. Salvage therapy included allogeneic stem cell transplantation (SCT) in 74 patients, standard-dose cytosine arabinoside (ara-C) combinations in 30 patients, high-dose ara-C combinations in 171 patients, non-ara-C combinations in 73 patients, and Phase I-II single agents in 246 patients. RESULTS. Overall, 76 patients (13%) achieved CR. The median CR duration was 7 months. The median survival was 1.5 months, and the 1-year survival rate was 8%. A multivariate analysis of prognostic factors for CR identified the following 6 independent adverse factors: first CR duration < 6 months; second CR duration < 6 months; salvage therapy not including allogeneic SCT; non-inversion 16 AML; platelet counts < 50 × 109/L, and leukocytosis > 50 × 109/L. Patients were divided into low-risk (1-2 adverse factors; 8%), intermediate 1 (3 factors; 20%), intermediate 2 (4 factors; 38%), and high-risk groups (5-6 factors; 33%) with respective CR rates of 54%, 26%, 8%, and 0%. The respective 1-year survival rates were 36%, 21%, 6%, and 1%. A multivariate analysis for survival identified the following 7 independent adverse factors: first CR duration < 12 months; second CR duration < 6 months; bilirubin level ≥ 1 mg/dL; albumin level < 3 g/dL; age > 60 years; bone marrow blasts ≥ 50%; and year of therapy before 1991. Patients were divided into low-risk (0-2 adverse factors; 39%), intermediate (3 factors; 27%), and high-risk groups (≥ 4 factors; 34%) with estimated 1-year survival rates of 22%, 6%, and 0%, respectively. The respective CR rates were 26%, 8%, and 2%. CONCLUSIONS. The current analysis established the outcome and prognostic factors associated with second salvage therapy in AML. It also proposed risk models and groups that could be used for comparison of results of present and future investigational strategies.

KW - Acute myelogenous leukemia

KW - Complete response

KW - Cytosine arabinoside

KW - Salvage therapy

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