PROLONGED SURVIVAL IS ACHIEVABLE FOR A QUARTER OF PATIENTS IN PRIMARY INDUCTION FAILURE FOR ACUTE MYELOID LEUKEMIA, BUT DOES NOT RELY ON REPEATED SALVAGE THERAPY – A MONOCENTRIC RETROSPECTIVE STUDY
(Abstract release date: 05/19/16)
EHA Library. Ledoux M. 06/09/16; 132463; E914
Dr. Marie-Pierre Ledoux
Contributions
Contributions
Abstract
Abstract: E914
Type: Eposter Presentation
Background
Response to first induction chemotherapy is a strong prognostic factor in patients with newly diagnosed acute myeloid leukemia (AML) eligible for intensive treatment. Primary induction failure (PIF) leads to an escalation of therapeutic means, the benefit of which remains controversial.
Aims
Allogeneic hematopoietic stem cell transplantation (HSCT) appears to be the most appropriate consolidation treatment to lower relapse risk but determining its best timing is still a challenge: disease-free (DFS) and overall survivals (OS) are known to be better if allogeneic HSCT is done in complete remission (CR), but earlier transplant is usually associated with a better outcome. These two conditions seem to pull in opposite directions in PIF AML.
Methods
We therefore conducted a retrospective monocentric study analyzing the outcome of all adult patients with newly diagnosed AML in Strasbourg University Hospital between 2002 and 2014 and failing to achieve remission after first induction.
Results
Of 704 AML patients, 394 (56.0%) received intensive chemotherapy, and 90 (22.8%) were considered PIF. Sixty-three of these patients (70.0%) received further intensive treatment, enabling a median OS of 418 days, compared to 65 days for patients on palliative care and 253 days for patients receiving hypomethylating agents only (p<0.001). Salvage chemotherapy led to CR in 40% of patients, and those having received an allogeneic HSCT while still on CR reached a median OS of 2068 days, with a three-year survival of 57.4%. Patients in CR after salvage therapy but who were not subsequently transplanted had a median OS of only 551 days. Patients receiving more than one salvage chemotherapy before being transplanted had a median OS of 418 days, compared with 467 days for patients who were transplanted while refractory without or after only one salvage therapy (p=0.7). Among the 23 patients still refractory at transplantation, allogeneic HSCT eventually led to remission in 20 patients (87%), but with a high subsequent relapse rate. Allogeneic HSCT in refractory patients led to a median OS of 467 days, with three-year survival reaching 25.6%.On the whole, the three-year survival rate of the 38 patients who received an allogeneic HSCT was 39.5% compared with 2% for the 52 patients who did not undergo transplantation.
Conclusion
Continuing intensive treatment of AML after primary induction failure is still the better therapeutic option in terms of survival for fit patients: we have observed that it can result in prolonged survival, and perhaps cure, for roughly a quarter of them, supporting this approach. However, considering our data, receiving more than one salvage chemotherapy doesn’t appear to lead to a better outcome and may impair the rate of allogeneic HSCT. This might eventually affect the outcome of refractory patients, since allogeneic HSCT is a crucial step in their management. Although survival is consistently lower for patients lacking CR, allogeneic HSCT for refractory patients still offers prolonged survival to a significant proportion of PIF AML patients in spite of their initial dismal prognosis.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, HSCT, Salvage therapy
Type: Eposter Presentation
Background
Response to first induction chemotherapy is a strong prognostic factor in patients with newly diagnosed acute myeloid leukemia (AML) eligible for intensive treatment. Primary induction failure (PIF) leads to an escalation of therapeutic means, the benefit of which remains controversial.
Aims
Allogeneic hematopoietic stem cell transplantation (HSCT) appears to be the most appropriate consolidation treatment to lower relapse risk but determining its best timing is still a challenge: disease-free (DFS) and overall survivals (OS) are known to be better if allogeneic HSCT is done in complete remission (CR), but earlier transplant is usually associated with a better outcome. These two conditions seem to pull in opposite directions in PIF AML.
Methods
We therefore conducted a retrospective monocentric study analyzing the outcome of all adult patients with newly diagnosed AML in Strasbourg University Hospital between 2002 and 2014 and failing to achieve remission after first induction.
Results
Of 704 AML patients, 394 (56.0%) received intensive chemotherapy, and 90 (22.8%) were considered PIF. Sixty-three of these patients (70.0%) received further intensive treatment, enabling a median OS of 418 days, compared to 65 days for patients on palliative care and 253 days for patients receiving hypomethylating agents only (p<0.001). Salvage chemotherapy led to CR in 40% of patients, and those having received an allogeneic HSCT while still on CR reached a median OS of 2068 days, with a three-year survival of 57.4%. Patients in CR after salvage therapy but who were not subsequently transplanted had a median OS of only 551 days. Patients receiving more than one salvage chemotherapy before being transplanted had a median OS of 418 days, compared with 467 days for patients who were transplanted while refractory without or after only one salvage therapy (p=0.7). Among the 23 patients still refractory at transplantation, allogeneic HSCT eventually led to remission in 20 patients (87%), but with a high subsequent relapse rate. Allogeneic HSCT in refractory patients led to a median OS of 467 days, with three-year survival reaching 25.6%.On the whole, the three-year survival rate of the 38 patients who received an allogeneic HSCT was 39.5% compared with 2% for the 52 patients who did not undergo transplantation.
Conclusion
Continuing intensive treatment of AML after primary induction failure is still the better therapeutic option in terms of survival for fit patients: we have observed that it can result in prolonged survival, and perhaps cure, for roughly a quarter of them, supporting this approach. However, considering our data, receiving more than one salvage chemotherapy doesn’t appear to lead to a better outcome and may impair the rate of allogeneic HSCT. This might eventually affect the outcome of refractory patients, since allogeneic HSCT is a crucial step in their management. Although survival is consistently lower for patients lacking CR, allogeneic HSCT for refractory patients still offers prolonged survival to a significant proportion of PIF AML patients in spite of their initial dismal prognosis.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, HSCT, Salvage therapy
Abstract: E914
Type: Eposter Presentation
Background
Response to first induction chemotherapy is a strong prognostic factor in patients with newly diagnosed acute myeloid leukemia (AML) eligible for intensive treatment. Primary induction failure (PIF) leads to an escalation of therapeutic means, the benefit of which remains controversial.
Aims
Allogeneic hematopoietic stem cell transplantation (HSCT) appears to be the most appropriate consolidation treatment to lower relapse risk but determining its best timing is still a challenge: disease-free (DFS) and overall survivals (OS) are known to be better if allogeneic HSCT is done in complete remission (CR), but earlier transplant is usually associated with a better outcome. These two conditions seem to pull in opposite directions in PIF AML.
Methods
We therefore conducted a retrospective monocentric study analyzing the outcome of all adult patients with newly diagnosed AML in Strasbourg University Hospital between 2002 and 2014 and failing to achieve remission after first induction.
Results
Of 704 AML patients, 394 (56.0%) received intensive chemotherapy, and 90 (22.8%) were considered PIF. Sixty-three of these patients (70.0%) received further intensive treatment, enabling a median OS of 418 days, compared to 65 days for patients on palliative care and 253 days for patients receiving hypomethylating agents only (p<0.001). Salvage chemotherapy led to CR in 40% of patients, and those having received an allogeneic HSCT while still on CR reached a median OS of 2068 days, with a three-year survival of 57.4%. Patients in CR after salvage therapy but who were not subsequently transplanted had a median OS of only 551 days. Patients receiving more than one salvage chemotherapy before being transplanted had a median OS of 418 days, compared with 467 days for patients who were transplanted while refractory without or after only one salvage therapy (p=0.7). Among the 23 patients still refractory at transplantation, allogeneic HSCT eventually led to remission in 20 patients (87%), but with a high subsequent relapse rate. Allogeneic HSCT in refractory patients led to a median OS of 467 days, with three-year survival reaching 25.6%.On the whole, the three-year survival rate of the 38 patients who received an allogeneic HSCT was 39.5% compared with 2% for the 52 patients who did not undergo transplantation.
Conclusion
Continuing intensive treatment of AML after primary induction failure is still the better therapeutic option in terms of survival for fit patients: we have observed that it can result in prolonged survival, and perhaps cure, for roughly a quarter of them, supporting this approach. However, considering our data, receiving more than one salvage chemotherapy doesn’t appear to lead to a better outcome and may impair the rate of allogeneic HSCT. This might eventually affect the outcome of refractory patients, since allogeneic HSCT is a crucial step in their management. Although survival is consistently lower for patients lacking CR, allogeneic HSCT for refractory patients still offers prolonged survival to a significant proportion of PIF AML patients in spite of their initial dismal prognosis.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, HSCT, Salvage therapy
Type: Eposter Presentation
Background
Response to first induction chemotherapy is a strong prognostic factor in patients with newly diagnosed acute myeloid leukemia (AML) eligible for intensive treatment. Primary induction failure (PIF) leads to an escalation of therapeutic means, the benefit of which remains controversial.
Aims
Allogeneic hematopoietic stem cell transplantation (HSCT) appears to be the most appropriate consolidation treatment to lower relapse risk but determining its best timing is still a challenge: disease-free (DFS) and overall survivals (OS) are known to be better if allogeneic HSCT is done in complete remission (CR), but earlier transplant is usually associated with a better outcome. These two conditions seem to pull in opposite directions in PIF AML.
Methods
We therefore conducted a retrospective monocentric study analyzing the outcome of all adult patients with newly diagnosed AML in Strasbourg University Hospital between 2002 and 2014 and failing to achieve remission after first induction.
Results
Of 704 AML patients, 394 (56.0%) received intensive chemotherapy, and 90 (22.8%) were considered PIF. Sixty-three of these patients (70.0%) received further intensive treatment, enabling a median OS of 418 days, compared to 65 days for patients on palliative care and 253 days for patients receiving hypomethylating agents only (p<0.001). Salvage chemotherapy led to CR in 40% of patients, and those having received an allogeneic HSCT while still on CR reached a median OS of 2068 days, with a three-year survival of 57.4%. Patients in CR after salvage therapy but who were not subsequently transplanted had a median OS of only 551 days. Patients receiving more than one salvage chemotherapy before being transplanted had a median OS of 418 days, compared with 467 days for patients who were transplanted while refractory without or after only one salvage therapy (p=0.7). Among the 23 patients still refractory at transplantation, allogeneic HSCT eventually led to remission in 20 patients (87%), but with a high subsequent relapse rate. Allogeneic HSCT in refractory patients led to a median OS of 467 days, with three-year survival reaching 25.6%.On the whole, the three-year survival rate of the 38 patients who received an allogeneic HSCT was 39.5% compared with 2% for the 52 patients who did not undergo transplantation.
Conclusion
Continuing intensive treatment of AML after primary induction failure is still the better therapeutic option in terms of survival for fit patients: we have observed that it can result in prolonged survival, and perhaps cure, for roughly a quarter of them, supporting this approach. However, considering our data, receiving more than one salvage chemotherapy doesn’t appear to lead to a better outcome and may impair the rate of allogeneic HSCT. This might eventually affect the outcome of refractory patients, since allogeneic HSCT is a crucial step in their management. Although survival is consistently lower for patients lacking CR, allogeneic HSCT for refractory patients still offers prolonged survival to a significant proportion of PIF AML patients in spite of their initial dismal prognosis.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, HSCT, Salvage therapy
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