2013, Number 4
Evaluation of induction and consolidation classic treatment in de Novo acute non-lymphoblastic leukemia
Language: Spanish
References: 27
Page:
PDF size: 259.15 Kb.
ABSTRACT
Introduction: validation of cytogenetic and molecular abnormalities present at diagnosis is the most important prognostic factors of acute non-lymphoblastic leukemia. This has allowed us to establish the individual risk, stratify the patients and individualize their treatment.Objective: to describe the clinical behavior and outcome of patients with acute de novo non-lymphoblastic non-promyelocytic leukemia, receiving induction and classic consolidation therapy at the Department of Hematology of the Clinical Surgical Hospital "Hermanos Ameijeiras".
Methods: a descriptive, prospective longitudinal study was carried out with 23 patients admitted between May 2008 and January 2011. Patients were stratified into: favorable, intermediate, poor risk groups, according to biological, molecular and cytogenetics clinical prognostic factors.
Results: 60.9 % of patients had leukocyte counts less than 25 x 109/L, 47.8 % had myelomonocytic variant, 21.7 % had normal karyotype and 10% had translocation (8; 21). Mutations of the genes FLT3 and NPM1 were present in 2 and 3 patients respectively. 84 % of patients undergoing induction therapy achieved complete remission, predominantly the ones in the favorable risk group with no significant differences. In the favorable molecular risk group, the number of complete remissions was significantly higher (85.7 %) (p=0.05). The group of favorable risk patients remaining in complete remission with the consolidation treatment had 54.5 %, although it was not significant.
Conclusions: the disease free survival was greater whereas overall survival rate was similar to the data reported in the international literature. Both were higher within the favorable risk group but without no significant difference, what is considered an important achievement of Cuban Healthcare System.
REFERENCES
Castaigne S, Chevret S, Archimbaud E, Fenaux P, Bordessoule D, Tilly H, et al. Randomized comparison of double induction and timed-sequential induction to a "3 + 7" induction in adults with AML: long-term analysis of the Acute Leukemia French Association (ALFA) 9000 study. Blood 2004 Oct 15;104(8):2467-74.
Rowe JM, Kim HT, Cassileth PA, Lazarus HM, Litzow MR, Wiernik PH et al. Adult patients with acute myeloid leukemia who achieve complete remission after 1 or 2 cycles of induction have a similar prognosis: a report on 1980 patients registered to 6 studies conducted by the Eastern Cooperative Oncology Group. Cancer. 2010 Nov 1;116(21):5012-21.
Green CL, Koo KK, Hills RK, Burnett AK, Linch DC, Gale RE. Prognostic significance of CEBPA mutations in a large cohort of younger adult patients with acute myeloid leukemia: impact of double CEBPA mutations and the interaction with FLT3 and NPM1 mutations. J Clin Oncol. 2010 Jun 1;28(16):2739-47. Epub 2010 May 3.
Zhu X, Ma Y, Liu D. Novel agents and regimens for acute myeloid leukemia: 2009 ASH annual meeting highlights. J Hematol Oncol, 2010 Apr;3:17 19. Kern W, Haferlach T, Schoch C, Loffler H, Gassmann W, Heinecke A, et al. Early blast clearance by remission induction therapy is a major independent prognostic factor for both achievement of complete remission and long-term outcome in acute myeloid leukemia: data from the German AML(AMLCG) 1992 Trial.. Blood 2003 Jan 1;101(1):64-70. Epub 2002 Jun 28.
Kern W, Haferlach T, Schoch C, Loffler H, Gassmann W, Heinecke A, et al. Early blast clearance by remission induction therapy is a major independent prognostic factor for both achievement of complete remission and long-term outcome in acute myeloid leukemia: data from the German AML(AMLCG) 1992 Trial.. Blood 2003 Jan 1;101(1):64-70. Epub 2002 Jun 28.
Rowe JM, Kim HT, Cassileth PA, Lazarus HM, Litzow MR, Wiernik PH et al. Adult patients with acute myeloid leukemia who achieve complete remission after 1 or 2 cycles of induction have a similar prognosis: a report on 1980 patients registered to 6 studies conducted by the Eastern Cooperative Oncology Group. Cancer. 2010 Nov 1;116(21):5012-21.