Acta Haematol: Impact of chemotherapy or allogeneic stem cell transplantation as salvage therapy in patients with refractory acute myeloid leukemia

Overall outcomes for patients with refractory AML (rAML) remain poor
.

Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered the only curative therapy, it is generally only recommended for patients in remission after salvage chemotherapy

Overall outcomes for patients with refractory AML (rAML) remain poor

Table 1: Patient characteristics of all patients

Table 1: Patient characteristics of all patients

A total of 29 patients received allo-HSCT directly without salvage chemotherapy, and 26 patients achieved complete remission (CR) or complete remission with incomplete hematologic recovery (CRi) after transplantation, 4-year leukemia -free survival (LFS) and Overall survival (OS) was 45.

0 ± 10.
7 and 51.
0 ± 10.
6%, respectively

A total of 29 patients received allo-HSCT directly without salvage chemotherapy, and 26 patients achieved complete remission (CR) or complete remission with incomplete hematologic recovery (CRi) after transplantation, 4-year leukemia -free survival (LFS) and Overall survival (OS) was 45.

Figure 1: Patient flow chart and results by treatment group
.

LFS, leukemia-free survival; OS, overall survival; all-HSCT, allogeneic hematopoietic stem cell transplantation; CR, complete remission

Figure 1: Patient flow chart and results by treatment group

Table 2: Univariate analysis of patient and treatment-related factors associated with OS and LFS

Table 2: Univariate analysis of patient and treatment-related factors associated with OS and LFS

Table 3: Multivariate analysis of OS and LFS-related prognostic factors in all patients ( n= 220)

Table 3: Multivariate analysis of OS and LFS-related prognostic factors in all patients ( n= 220) n

An additional 191 patients received salvage chemotherapy, and 81 (42.
2%) patients achieved CR or CRi
.

Thirty-four of these patients subsequently underwent allo-HSCT, and the 4-year LFS and OS were 46.

An additional 191 patients received salvage chemotherapy, and 81 (42.

Figure 2: Kaplan-Meier curves of OS and LFS in patients receiving intensive salvage chemotherapy, non-intensive salvage chemotherapy, and direct allo-HSCT without allo-HSCT
.

LFS, leukemia-free survival; OS, overall survival; all-HSCT, allogeneic hematopoietic stem cell transplantation

Figure 2: Kaplan-Meier curves of OS and LFS in patients receiving intensive salvage chemotherapy, non-intensive salvage chemotherapy, and direct allo-HSCT without allo-HSCT

Figure 3: Kaplan-Meier curves of OS and LFS in patients with or without allo-HSCT

Figure 4: Kaplan-Meier curves of OS and LFS in patients aged <40 and ≥40 years
.

LFS, leukemia-free survival; OS, overall survival; all-HSCT, allogeneic hematopoietic stem cell transplantation

Figure 4: Kaplan-Meier curves of OS and LFS in patients aged <40 and ≥40 years
.
LFS, leukemia-free survival; OS, overall survival; all-HSCT, allogeneic hematopoietic stem cell transplantation

For patients who received salvage chemotherapy but not allo-HSCT, very few of them became long-term survivors
.
In multivariate analysis, salvage chemotherapy and chemotherapy intensity failed to have a significant effect on OS and LFS
.
In multivariate analysis, Allo-HSCT was the only prognostic factor that improved OS and LFS
.
Although a possible bias of the study is the lack of a description or definition of rAML aggressiveness, in general, the research team believes that allo-HSCT is beneficial for rAML patients, and that direct allo-HSCT without salvage chemotherapy may be a treatment option and warranted A prospective clinical study with minimal selection bias was performed to evaluate the effect of direct allo-HSCT in young adult patients with rAML
.

For patients who received salvage chemotherapy but not allo-HSCT, very few of them became long-term survivors
.
In multivariate analysis, salvage chemotherapy and chemotherapy intensity failed to have a significant effect on OS and LFS
.
In multivariate analysis, Allo-HSCT was the only prognostic factor that improved OS and LFS
.
Although a possible bias of the study is the lack of a description or definition of rAML aggressiveness, in general, the research team believes that allo-HSCT is beneficial for rAML patients, and that direct allo-HSCT without salvage chemotherapy may be a treatment option and warranted A prospective clinical study with minimal selection bias was performed to evaluate the effect of direct allo-HSCT in young adult patients with rAML
.
Although a possible bias of the study is the lack of a description or definition of rAML aggressiveness, in general, the research team believes that allo-HSCT is beneficial for rAML patients, and that direct allo-HSCT without salvage chemotherapy may be a treatment option and warranted A prospective clinical study with minimal selection bias was performed to evaluate the effect of direct allo-HSCT in young adult patients with rAML
.
Although a possible bias of the study is the lack of a description or definition of rAML aggressiveness, in general, the research team believes that allo-HSCT is beneficial for rAML patients, and that direct allo-HSCT without salvage chemotherapy may be a treatment option and warranted A prospective clinical study with minimal selection bias was performed to evaluate the effect of direct allo-HSCT in young adult patients with rAML
.

 

Original source:

Original source:

Wang ZY, Gao WH, Zhao HJ, Yin CR, Wang ZW, Tian L, Wang L, Wang LN, Jiang JL, Devillier R, Wan M, Wang JM, Huang PP, Blaise D, Hu J.
Chemotherapy or Allogeneic Stem Cell Transplantation as Salvage Therapy for Patients with Refractory Acute Myeloid Leukemia: A Multicenter Analysis.
Acta Haematol.
2022 Mar 1:1-11.
doi: 10.
1159/000511144.
Epub ahead of print.
PMID: 35231903.

Wang ZY, Gao WH, Zhao HJ, Yin CR, Wang ZW, Tian L, Wang L, Wang LN, Jiang JL, Devillier R, Wan M, Wang JM, Huang PP, Blaise D, Hu J.
Chemotherapy or Allogeneic Stem Cell Transplantation as Salvage Therapy for Patients with Refractory Acute Myeloid Leukemia: A Multicenter Analysis.
Acta Haematol.
2022 Mar 1:1-11.
doi: 10.
1159/000511144.
Epub ahead of print.
PMID: 35231903.
Wang ZY, Gao WH, Zhao HJ , Yin CR, Wang ZW, Tian L, Wang L, Wang LN, Jiang JL, Devillier R, Wan M, Wang JM, Huang PP, Blaise D, Hu J.
Chemotherapy or Allogeneic Stem Cell Transplantation as Salvage Therapy for Patients with Refractory Acute Myeloid Leukemia: A Multicenter Analysis.
Acta Haematol.
2022 Mar 1:1-11.
doi: 10.
1159/000511144.
Epub ahead of print.
PMID: 35231903.
Wang ZY, Gao WH, Zhao HJ, Yin CR, Wang ZW, Tian L, Wang L, Wang LN, Jiang JL, Devillier R, Wan M, Wang JM, Huang PP, Blaise D, Hu J.
Chemotherapy or Allogeneic Stem Cell Transplantation as Salvage Therapy for Patients with Refractory Acute Myeloid Leukemia: A Multicenter Analysis.
Acta Haematol.
2022 Mar 1:1-11.
doi: 10.
1159/000511144.
Epub ahead of print.
PMID: 35231903.
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