Comparison of salvage chemotherapy regimens and prognostic significance of minimal residual disease in relapsed/refractory acute myeloid leukemia. Leuk Lymphoma 2021 Jan;62(1):158-166
Date
09/22/2020Pubmed ID
32951486DOI
10.1080/10428194.2020.1821009Scopus ID
2-s2.0-85091139710 (requires institutional sign-in at Scopus site) 10 CitationsAbstract
We compared the outcomes of salvage chemotherapy in 146 patients with relapsed (57.5%) or refractory (42.5%) AML who received CLAG-M (51%), MEC (39%) or CLAG (10%). Minimal residual disease (MRD) was assessed by flow cytometry. Bivariate, Kaplan-Meier, and Cox regression analyses were conducted. Complete remission (CR) rate of 46% (CLAG-M 54% versus MEC/CLAG 40%, p = .045) was observed with MRD-negative CR of 33% (CLAG-M 39% versus MEC/CLAG 22%, p = .042). Median overall survival (OS) was 9.7 months; the longest OS occurred with CLAG-M (13.3, 95%CI 2.4-24.3) versus MEC (6.9, 95%CI 2.9-10.9) or CLAG (6.2, 95%CI 2.4-12.6) (p = .025). When adjusted for age, gender, relapsed/refractory AML, poor risk AML, MRD, chemotherapy and transplant, CLAG-M (HR 0.63, 95% CI 0.40-0.98, p = .042), MRD-negativity (HR 0.15, 95% CI 0.07-0.30, p < .001) and transplant (HR 0.22, 95% CI 0.13-0.39, p < .001) were associated with higher OS. Our findings confirm that CLAG-M is a reasonable salvage regimen for RR-AML followed by transplant.
Author List
Mushtaq MU, Harrington AM, Chaudhary SG, Michaelis LC, Carlson KB, Abedin S, Runass L, Callander NS, Fallon MJ, Juckett M, Hall AC, Hematti P, Mattison RJ, Atallah EL, Guru Murthy GSAuthors
Sameem Abedin MD Associate Professor in the Medicine department at Medical College of WisconsinEhab L. Atallah MD Professor in the Medicine department at Medical College of Wisconsin
Karen-Sue B. Carlson MD, PhD Associate Professor in the Medicine department at Medical College of Wisconsin
Alexandra M. Harrington MD Professor in the Pathology department at Medical College of Wisconsin
Peiman Hematti MD Professor in the Medicine department at Medical College of Wisconsin
Laura Michaelis MD Chief, Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Antineoplastic Combined Chemotherapy ProtocolsCladribine
Cytarabine
Humans
Leukemia, Myeloid, Acute
Neoplasm, Residual
Prognosis
Remission Induction
Salvage Therapy