Long-term outcome of high risk patients with myelodysplastic syndromes or secondary acute myeloid leukemia receiving intensive chemotherapy View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2018-08-04

AUTHORS

Esther Schuler, Natalie Zadrozny, Sabine Blum, Thomas Schroeder, Corinna Strupp, Barbara Hildebrandt, Andrea Kündgen, Norbert Gattermann, Carlo Aul, Mustafa Kondakci, Guido Kobbe, Rainer Haas, Ulrich Germing

ABSTRACT

Intensive chemotherapy (IC) used to be a common treatment approach for patients with higher-risk myelodysplastic syndromes (MDS) or acute myeloid leukemia after MDS (sAML). We conducted a retrospective analysis of 299 patients, including a matched pair analysis comparing 96 patients receiving IC with 96 patients not undergoing IC, in order to evaluate the impact of IC on overall survival (OS) and to identify factors that influence remission rates and OS. Complete remission (CR) after first induction chemotherapy was reached in 50% of patients. Parameters influencing the probability of achieving CR were blast count in the bone marrow (< 30%), age < 65 years, presence of Auer rods, duration of antecedent MDS shorter than 6 months, and timing of IC in relation to first diagnosis. The difference in survival time was not significantly better for patients receiving IC (median OS 12.7 months vs. 7 months). Parameters favorably influencing survival were the presence of Auer rods, age below 60 years, blast count below 30%, IC given shortly after first diagnosis, and achievement of CR. On multivariate analysis, achieving CR, presence of Auer rods, and percentage of blasts below or above 30% significantly influenced median survival. Relapse occurred in 63% of patients after a median of 9.9 months with a median survival of 7.6 months. Considering the high relapse rate and short survival, we conclude that intensive chemotherapy is not promising for high-risk MDS or sAML. More... »

PAGES

2325-2332

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00277-018-3466-7

DOI

http://dx.doi.org/10.1007/s00277-018-3466-7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1106003360

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30078145


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28 schema:description Intensive chemotherapy (IC) used to be a common treatment approach for patients with higher-risk myelodysplastic syndromes (MDS) or acute myeloid leukemia after MDS (sAML). We conducted a retrospective analysis of 299 patients, including a matched pair analysis comparing 96 patients receiving IC with 96 patients not undergoing IC, in order to evaluate the impact of IC on overall survival (OS) and to identify factors that influence remission rates and OS. Complete remission (CR) after first induction chemotherapy was reached in 50% of patients. Parameters influencing the probability of achieving CR were blast count in the bone marrow (< 30%), age < 65 years, presence of Auer rods, duration of antecedent MDS shorter than 6 months, and timing of IC in relation to first diagnosis. The difference in survival time was not significantly better for patients receiving IC (median OS 12.7 months vs. 7 months). Parameters favorably influencing survival were the presence of Auer rods, age below 60 years, blast count below 30%, IC given shortly after first diagnosis, and achievement of CR. On multivariate analysis, achieving CR, presence of Auer rods, and percentage of blasts below or above 30% significantly influenced median survival. Relapse occurred in 63% of patients after a median of 9.9 months with a median survival of 7.6 months. Considering the high relapse rate and short survival, we conclude that intensive chemotherapy is not promising for high-risk MDS or sAML.
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35 SAML
36 achievement
37 achievement of CR
38 acute myeloid leukemia
39 age
40 analysis
41 antecedent myelodysplastic syndrome
42 approach
43 blast count
44 blasts
45 bone marrow
46 chemotherapy
47 common treatment approach
48 complete remission
49 count
50 diagnosis
51 differences
52 duration
53 factors
54 first diagnosis
55 first induction chemotherapy
56 high relapse rate
57 high-risk myelodysplastic syndrome
58 high-risk patients
59 impact
60 induction chemotherapy
61 intensive chemotherapy
62 leukemia
63 long-term outcomes
64 marrow
65 median
66 median survival
67 months
68 multivariate analysis
69 myelodysplastic syndrome
70 myeloid leukemia
71 order
72 outcomes
73 overall survival
74 pair analysis
75 parameters
76 patients
77 percentage
78 percentage of blasts
79 presence
80 probability
81 rate
82 relapse
83 relapse rate
84 relation
85 remission
86 remission rate
87 retrospective analysis
88 risk patients
89 rods
90 secondary acute myeloid leukemia
91 shorter survival
92 survival
93 survival time
94 syndrome
95 time
96 timing
97 treatment approaches
98 years
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