Outcome of high-dose cytarabine-based induction therapy followed by hematopoietic stem cell transplantation in acute myeloid leukemia: influence of karyotype

Abstract

One-hundred-twenty consecutive adult patients aged 15–69 years (median 40) with acute myeloid leukemia (AML) excluding t(15;17) received induction therapy comprising idarubicin, high-dose cytarabine and etoposide. Planned post-induction treatment included two courses of moderate-intensity consolidation therapy followed by stem cell transplantation. 11 patients (9%) died during induction therapy. The complete remission (CR) rate with a single cycle of induction therapy was 71%. The overall CR rate, after salvage chemotherapy but excluding allogeneic transplantation for primary refractory disease, was 82%. CR rates with one cycle of therapy for patients with good, intermediate and poor karyotype were 96, 72 and 41%, respectively (P < 0.0001). The impact of karyotype on the overall CR rate was also significant (96 vs. 88 vs. 59%; P = 0.001). Overall, 84 of 98 patients (86%) attaining CR underwent autologous (n = 59), allogeneic (n = 23) or syngeneic (n = 2) hematopoietic stem cell transplantation in first CR. The 5-year overall survival (OS) of 43% (95% CI: 34–52%) was significantly influenced by the karyotype: good 73%, intermediate 41%, and poor 18% (P = 0.0001). These data suggest that the sequence of therapy employed is active in AML, but additional steps are needed to improve the outcome of patients with intermediate- and high-risk cytogenetic abnormalities.

Keywords:

• Clinical results
• myeloid leukemias and dysplasias
• myeloproliferative disorders