Comparison of salvage chemotherapy regimens and prognostic significance of minimal residual disease in relapsed/refractory acute myeloid leukemia

Muhammad Umair Mushtaq, Alexandra M. Harrington, Sibgha Gull Chaudhary, Laura C. Michaelis, Karen Sue B. Carlson, Sameem Abedin, Lyndsey Runass, Natalie S. Callander, Michael J. Fallon, Mark Juckett, Aric C. Hall, Peiman Hematti, Ryan J. Mattison, Ehab L. Atallah, Guru Subramanian Guru Murthy

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)158-166
Number of pages9
JournalLeukemia and Lymphoma
Volume62
Issue number1
DOIs
StatePublished - Jan 2021
Externally publishedYes

Bibliographical note

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.

Keywords

  • Acute myeloid leukemia
  • hematopoietic stem cell transplant
  • minimal residual disease
  • relapsed/refractory leukemia
  • salvage chemotherapy

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