Prognostic factors and outcomes of adult patients with acute myeloid leukemia after first relapse

Saiko Kurosawa, Takuhiro Yamaguchi, Shuichi Miyawaki, Naoyuki Uchida, Toru Sakura, Heiwa Kanamori, Kensuke Usuki, Takuya Yamashita, Yasushi Okoshi, Hirohiko Shibayama, Hirohisa Nakamae, Momoko Mawatari, Kazuo Hatanaka, Kazutaka Sunami, Manabu Shimoyama, Naohito Fujishima, Yoshinobu Maeda, Ikuo Miura, Yoichi Takaue, Takahiro Fukuda

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Background Patients with acute myeloid leukemia who are treated with conventional chemotherapy still have a substantial risk of relapse; the prognostic factors and optimal treatments after relapse have not been fully established. We, therefore, retrospectively analyzed data from patients with acute myeloid leukemia who had achieved first complete remission to assess their prognosis after first relapse. Design and Methods Clinical data were collected from 70 institutions across the country on adult patients who were diagnosed with acute myeloid leukemia and who had achieved a first complete remission after one or two courses of induction chemotherapy. Results Among the 1,535 patients who were treated with chemotherapy alone, 1,015 relapsed. Half of them subsequently achieved a second complete remission. The overall survival was 30% at 3 years after relapse. Multivariate analysis showed that achievement of second complete remission, salvage allogeneic hematopoietic cell transplantation, and a relapse-free interval of 1 year or longer were independent prognostic factors. The outcome after allogeneic transplantation in second complete remission was comparable to that after transplantation in first complete remission. Patients with acute myeloid leukemia and cytogenetic risk factors other than inv(16) or t(8;21) had a significantly worse outcome when they did not undergo salvage transplantation even when they achieved second complete remission. Conclusions We found that both the achievement of second complete remission and the application of salvage transplantation were crucial for improving the prognosis of patients with acute myeloid leukemia in first relapse. Our results indicate that the optimal treatment strategy after first relapse may differ according to the cytogenetic risk.

Original languageEnglish
Pages (from-to)1857-1864
Number of pages8
JournalHaematologica
Volume95
Issue number11
DOIs
Publication statusPublished - Nov 2010

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Acute Myeloid Leukemia
Recurrence
Transplantation
Cytogenetics
Drug Therapy
Induction Chemotherapy
Cell Transplantation
Homologous Transplantation
Multivariate Analysis
Survival
Therapeutics

Keywords

  • Acute myeloid leukemia
  • Allogeneic hematopoietic cell transplantation
  • Cytogenetic risk
  • First relapse
  • Second remission

ASJC Scopus subject areas

  • Hematology

Cite this

Kurosawa, S., Yamaguchi, T., Miyawaki, S., Uchida, N., Sakura, T., Kanamori, H., ... Fukuda, T. (2010). Prognostic factors and outcomes of adult patients with acute myeloid leukemia after first relapse. Haematologica, 95(11), 1857-1864. https://doi.org/10.3324/haematol.2010.027516

Prognostic factors and outcomes of adult patients with acute myeloid leukemia after first relapse. / Kurosawa, Saiko; Yamaguchi, Takuhiro; Miyawaki, Shuichi; Uchida, Naoyuki; Sakura, Toru; Kanamori, Heiwa; Usuki, Kensuke; Yamashita, Takuya; Okoshi, Yasushi; Shibayama, Hirohiko; Nakamae, Hirohisa; Mawatari, Momoko; Hatanaka, Kazuo; Sunami, Kazutaka; Shimoyama, Manabu; Fujishima, Naohito; Maeda, Yoshinobu; Miura, Ikuo; Takaue, Yoichi; Fukuda, Takahiro.

In: Haematologica, Vol. 95, No. 11, 11.2010, p. 1857-1864.

Research output: Contribution to journalArticle

Kurosawa, S, Yamaguchi, T, Miyawaki, S, Uchida, N, Sakura, T, Kanamori, H, Usuki, K, Yamashita, T, Okoshi, Y, Shibayama, H, Nakamae, H, Mawatari, M, Hatanaka, K, Sunami, K, Shimoyama, M, Fujishima, N, Maeda, Y, Miura, I, Takaue, Y & Fukuda, T 2010, 'Prognostic factors and outcomes of adult patients with acute myeloid leukemia after first relapse', Haematologica, vol. 95, no. 11, pp. 1857-1864. https://doi.org/10.3324/haematol.2010.027516
Kurosawa S, Yamaguchi T, Miyawaki S, Uchida N, Sakura T, Kanamori H et al. Prognostic factors and outcomes of adult patients with acute myeloid leukemia after first relapse. Haematologica. 2010 Nov;95(11):1857-1864. https://doi.org/10.3324/haematol.2010.027516
Kurosawa, Saiko ; Yamaguchi, Takuhiro ; Miyawaki, Shuichi ; Uchida, Naoyuki ; Sakura, Toru ; Kanamori, Heiwa ; Usuki, Kensuke ; Yamashita, Takuya ; Okoshi, Yasushi ; Shibayama, Hirohiko ; Nakamae, Hirohisa ; Mawatari, Momoko ; Hatanaka, Kazuo ; Sunami, Kazutaka ; Shimoyama, Manabu ; Fujishima, Naohito ; Maeda, Yoshinobu ; Miura, Ikuo ; Takaue, Yoichi ; Fukuda, Takahiro. / Prognostic factors and outcomes of adult patients with acute myeloid leukemia after first relapse. In: Haematologica. 2010 ; Vol. 95, No. 11. pp. 1857-1864.
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AU - Yamaguchi, Takuhiro

AU - Miyawaki, Shuichi

AU - Uchida, Naoyuki

AU - Sakura, Toru

AU - Kanamori, Heiwa

AU - Usuki, Kensuke

AU - Yamashita, Takuya

AU - Okoshi, Yasushi

AU - Shibayama, Hirohiko

AU - Nakamae, Hirohisa

AU - Mawatari, Momoko

AU - Hatanaka, Kazuo

AU - Sunami, Kazutaka

AU - Shimoyama, Manabu

AU - Fujishima, Naohito

AU - Maeda, Yoshinobu

AU - Miura, Ikuo

AU - Takaue, Yoichi

AU - Fukuda, Takahiro

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N2 - Background Patients with acute myeloid leukemia who are treated with conventional chemotherapy still have a substantial risk of relapse; the prognostic factors and optimal treatments after relapse have not been fully established. We, therefore, retrospectively analyzed data from patients with acute myeloid leukemia who had achieved first complete remission to assess their prognosis after first relapse. Design and Methods Clinical data were collected from 70 institutions across the country on adult patients who were diagnosed with acute myeloid leukemia and who had achieved a first complete remission after one or two courses of induction chemotherapy. Results Among the 1,535 patients who were treated with chemotherapy alone, 1,015 relapsed. Half of them subsequently achieved a second complete remission. The overall survival was 30% at 3 years after relapse. Multivariate analysis showed that achievement of second complete remission, salvage allogeneic hematopoietic cell transplantation, and a relapse-free interval of 1 year or longer were independent prognostic factors. The outcome after allogeneic transplantation in second complete remission was comparable to that after transplantation in first complete remission. Patients with acute myeloid leukemia and cytogenetic risk factors other than inv(16) or t(8;21) had a significantly worse outcome when they did not undergo salvage transplantation even when they achieved second complete remission. Conclusions We found that both the achievement of second complete remission and the application of salvage transplantation were crucial for improving the prognosis of patients with acute myeloid leukemia in first relapse. Our results indicate that the optimal treatment strategy after first relapse may differ according to the cytogenetic risk.

AB - Background Patients with acute myeloid leukemia who are treated with conventional chemotherapy still have a substantial risk of relapse; the prognostic factors and optimal treatments after relapse have not been fully established. We, therefore, retrospectively analyzed data from patients with acute myeloid leukemia who had achieved first complete remission to assess their prognosis after first relapse. Design and Methods Clinical data were collected from 70 institutions across the country on adult patients who were diagnosed with acute myeloid leukemia and who had achieved a first complete remission after one or two courses of induction chemotherapy. Results Among the 1,535 patients who were treated with chemotherapy alone, 1,015 relapsed. Half of them subsequently achieved a second complete remission. The overall survival was 30% at 3 years after relapse. Multivariate analysis showed that achievement of second complete remission, salvage allogeneic hematopoietic cell transplantation, and a relapse-free interval of 1 year or longer were independent prognostic factors. The outcome after allogeneic transplantation in second complete remission was comparable to that after transplantation in first complete remission. Patients with acute myeloid leukemia and cytogenetic risk factors other than inv(16) or t(8;21) had a significantly worse outcome when they did not undergo salvage transplantation even when they achieved second complete remission. Conclusions We found that both the achievement of second complete remission and the application of salvage transplantation were crucial for improving the prognosis of patients with acute myeloid leukemia in first relapse. Our results indicate that the optimal treatment strategy after first relapse may differ according to the cytogenetic risk.

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KW - Second remission

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