TY - JOUR
T1 - Comparison of salvage chemotherapy regimens and prognostic significance of minimal residual disease in relapsed/refractory acute myeloid leukemia
AU - Mushtaq, Muhammad Umair
AU - Harrington, Alexandra M.
AU - Chaudhary, Sibgha Gull
AU - Michaelis, Laura C.
AU - Carlson, Karen Sue B.
AU - Abedin, Sameem
AU - Runass, Lyndsey
AU - Callander, Natalie S.
AU - Fallon, Michael J.
AU - Juckett, Mark
AU - Hall, Aric C.
AU - Hematti, Peiman
AU - Mattison, Ryan J.
AU - Atallah, Ehab L.
AU - Guru Murthy, Guru Subramanian
N1 - Funding Information:
This work was supported by the University of Wisconsin Carbone Cancer Center Support Grant P30 CA014520.
Publisher Copyright:
© 2020 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2020/9/19
Y1 - 2020/9/19
N2 - 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.
AB - 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.
KW - Acute myeloid leukemia
KW - hematopoietic stem cell transplant
KW - minimal residual disease
KW - relapsed/refractory leukemia
KW - salvage chemotherapy
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U2 - 10.1080/10428194.2020.1821009
DO - 10.1080/10428194.2020.1821009
M3 - Article
C2 - 32951486
AN - SCOPUS:85091139710
SN - 1042-8194
VL - 62
SP - 158
EP - 166
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 1
ER -
