Blood Res 2017; 52(3):
Published online September 25, 2017
https://doi.org/10.5045/br.2017.52.3.174
© The Korean Society of Hematology
Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Correspondence to : Woo-Sung Min, M.D., Ph.D. Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 06591, Korea. wsmin@catholic.ac.kr
Standard remission induction chemotherapy consisting of anthracycline plus cytarabine (3+7) is administered for adult acute myeloid leukemia (AML). However, the effects of intensified regimen on complete remission (CR), relapse and overall survival (OS) remain unknown.
We analyzed 1195 patients treated with idarubicin plus cytarabine/BHAC (3+7) from 2002 to 2013. Among them, 731 received early intensification with 3-day cytarabine/BHAC (3+10, N=363) or 2-day idarubicin plus cytarabine/BHAC 3 days (5+10, N=368). The 3+10 and 5+10 strategies were applied to patients with bone marrow blast counts of 5?20% and >20% on day 7 of 3+7, respectively.
Early intensification correlated with a younger age (median: 40 vs. 45 yr) and higher t(8;21) frequency (20.4% vs. 7.1%), compared to 3+7. After early intensification, the early death rates were higher among the elderly (3+10 [15.7%], 5+10 [21.7%] vs. 3+7 [6.3%],
Early intensification correlated with higher CR and lower relapse rates, but not OS in young AML patients. In elderly patients, early intensification correlated with a higher early death rate and poorer OS.
Keywords Acute myeloid leukemia, Induction chemotherapy, Early intensification
Blood Res 2017; 52(3): 174-183
Published online September 25, 2017 https://doi.org/10.5045/br.2017.52.3.174
Copyright © The Korean Society of Hematology.
Jae-Ho Yoon, Hee-Je Kim, Dae-Hun Kwak, Gi June Min, Sung-Soo Park, Young-Woo Jeon, Sung-Eun Lee, Byung-Sik Cho, Ki-Seong Eom, Yoo-Jin Kim, Seok Lee, Chang-Ki Min, Seok-Goo Cho, Dong-Wook Kim, Jong Wook Lee, and Woo-Sung Min*
Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Correspondence to:Woo-Sung Min, M.D., Ph.D. Department of Hematology, Catholic Blood and Marrow Transplantation Center, Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 06591, Korea. wsmin@catholic.ac.kr
Standard remission induction chemotherapy consisting of anthracycline plus cytarabine (3+7) is administered for adult acute myeloid leukemia (AML). However, the effects of intensified regimen on complete remission (CR), relapse and overall survival (OS) remain unknown.
We analyzed 1195 patients treated with idarubicin plus cytarabine/BHAC (3+7) from 2002 to 2013. Among them, 731 received early intensification with 3-day cytarabine/BHAC (3+10, N=363) or 2-day idarubicin plus cytarabine/BHAC 3 days (5+10, N=368). The 3+10 and 5+10 strategies were applied to patients with bone marrow blast counts of 5?20% and >20% on day 7 of 3+7, respectively.
Early intensification correlated with a younger age (median: 40 vs. 45 yr) and higher t(8;21) frequency (20.4% vs. 7.1%), compared to 3+7. After early intensification, the early death rates were higher among the elderly (3+10 [15.7%], 5+10 [21.7%] vs. 3+7 [6.3%],
Early intensification correlated with higher CR and lower relapse rates, but not OS in young AML patients. In elderly patients, early intensification correlated with a higher early death rate and poorer OS.
Keywords: Acute myeloid leukemia, Induction chemotherapy, Early intensification
Treatment strategy for adult patients with acute myeloid leukemia (AML) at the Catholic Blood and Marrow Transplantation Center in Korea. Abbreviations: BHAC, N4-behenoyl-1-β-D-arabinofburanosyl cytosine; CR, complete remission; D7BM, bone marrow blast evaluation on day 7 of chemotherapy; HCT, hematopoietic cell transplantation; MSD, matched sibling donor; MTZ, mitoxantrone; URD, unrelated donor.
Early treatment outcomes according to the intensity of induction chemotherapy.
Overall survival (OS) and overall relapse rates according to the intensity of induction chemotherapy.
Table 1 . Baseline characteristics according to the intensity of induction chemotherapy..
a)
Abbreviations: APM, acute panmyelosis with myelofibrosis; ARA-C, cytarabine; BHAC, N4-behenoyl-1-β-D-arabinofuranosyl cytosine; BM, bone marrow; HCT, hematopoietic cell transplantation; MRC, myelodysplasia-related change; NOS, not otherwise specified; PB, peripheral blood..
Table 2 . Early treatment outcomes according to the intensity of induction treatment..
a)
Abbreviations: Allo, allogeneic; Auto, autologous; BM, bone marrow; CR, complete remission; CTx, chemotherapy; HCT, hematopoietic cell transplantation..
Table 3 . Multivariate analysis to identify the factors affecting early treatment outcomes and OS..
a)
Abbreviations: CTx, chemotherapy; HCT, hematopoietic cell transplantation; HR, hazard ratio..
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Treatment strategy for adult patients with acute myeloid leukemia (AML) at the Catholic Blood and Marrow Transplantation Center in Korea. Abbreviations: BHAC, N4-behenoyl-1-β-D-arabinofburanosyl cytosine; CR, complete remission; D7BM, bone marrow blast evaluation on day 7 of chemotherapy; HCT, hematopoietic cell transplantation; MSD, matched sibling donor; MTZ, mitoxantrone; URD, unrelated donor.
|@|~(^,^)~|@|Early treatment outcomes according to the intensity of induction chemotherapy.
Overall survival (OS) and overall relapse rates according to the intensity of induction chemotherapy.