scholarly journals Timed sequential induction chemotherapy and risk-adapted postremission therapy for acute myelogenous leukemia

2008 ◽  
Vol 83 (11) ◽  
pp. 831-834 ◽  
Author(s):  
Matt Kalaycio ◽  
Anjali Advani ◽  
Brad Pohlman ◽  
Mikkael Sekeres ◽  
Barbara Tripp ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Acute Myelogenous Leukemia ◽  
Myelogenous Leukemia ◽  
Acute Myelogenous ◽  
Postremission Therapy ◽  
Sequential Induction

scholarly journals Chemotherapy for acute myelogenous leukemia in children and adults: VAPA update

Blood ◽  
1983 ◽  
Vol 62 (2) ◽  
pp. 315-319 ◽  
Author(s):  
HJ Weinstein ◽  
RJ Mayer ◽  
DS Rosenthal ◽  
FS Coral ◽  
BM Camitta ◽  
...  
Keyword(s):  
Complete Remission ◽  
Maintenance Therapy ◽  
Induction Chemotherapy ◽  
Acute Myelogenous Leukemia ◽  
Myelogenous Leukemia ◽  
Kaplan Meier ◽  
High Incidence ◽  
Acute Myelogenous ◽  
Leukemia In Children

Abstract We designed a protocol (VAPA) that featured 14 mo of intensive postremission induction chemotherapy in an effort to improve remission durations for patients with acute myelogenous leukemia (AML). One hundred and seven patients under 50 yr of age were entered into this study. The rate of complete remission is 70%. A Kaplan-Meier analysis of patients entering remission predicts that 56% +/- 7% (+/-SE) of patients less than 18 yr and 45% +/- 9% of patients aged 18–50 yr will remain in remission at 3 yr (median follow-up is 43 mo). Patients with the monocytic subtype had a statistically significant shorter duration of remission (2-sided p less than 0.05). There was a high incidence of primary CNS relapse in children. Thirty-one of 41 patients who completed the regimen remain in remission without maintenance therapy. We conclude that the VAPA protocol continues to offer a promising approach to treatment of AML.

scholarly journals 1090. Practicing Antimicrobial Stewardship: De-escalating Empiric Antibiotics in Patients with Acute Myelogenous Leukemia and Neutropenic Fever

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S387-S388
Author(s):  
Risa Fuller ◽  
Erin Moshier ◽  
Samantha E Jacobs ◽  
Douglas Tremblay ◽  
Guido Lancman ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Acute Myelogenous Leukemia ◽  
Neutropenic Fever ◽  
Myelogenous Leukemia ◽  
Recurrent Fever ◽  
Antibacterial Prophylaxis ◽  
Single Temperature ◽  
Acute Myelogenous ◽  
Icu Transfer ◽  
Infectious Source

Abstract Background In the era of increased antibiotic resistance, minimizing the use of broad-spectrum antibiotics is essential. We sought to determine whether there was a difference in risk of recurrent fever in patients with acute myelogenous leukemia (AML) and neutropenic fever without an identifiable source in which antibacterials were de-escalated prior to neutrophil recovery compared with those that continued until recovery. Methods We performed a retrospective chart review of adult patients with AML undergoing induction chemotherapy at Mount Sinai Hospital in New York, NY from 2009–2017. Neutropenic fever was defined as a temperature of 100.4°F for 1 hour or single temperature of 101°F in a patient with an absolute neutrophil count (ANC) of less than 500 cells/μL. Febrile patients were treated with cefepime, piperacillin–tazobactam, or a carbapenem. De-escalation was defined as changing from one of these antibiotics to antibacterial prophylaxis such as levofloxacin, or discontinuing antibiotics. The primary outcome was recurrent neutropenic fever. Secondary outcomes were adverse events related to antibiotics, intensive care unit (ICU) transfer, and all-cause mortality. Results Of 390 AML patients undergoing induction chemotherapy, 135 had a neutropenic fever; of whom, 77 had no identifiable infectious source. Of those 77, 38 had antibiotics de-escalated prior to ANC recovery (“short”) and 39 had antibiotics continued until ANC recovery or discharge (“long”). Demographics were similar (Table 1). The median number of antibiotic days for the first fever was 9 in the short group and 15 in the long group (P = 0.0008) (Table 2). Risk of recurrent fever was 46% lower in the short group compared with the long group (hazard ratio 0.54, 95% CI: 0.34–0.88; P = 0.01). There was no significant difference in ICU transfer (P = 0.11) and in-hospital mortality (P = 0.36) between the short and long groups (Table 2). There were 7 adverse drug outcomes, 2 in the short group and 5 in the long group (Table 3). Conclusion Antibiotic de-escalation in AML patients with neutropenic fever with no identifiable infectious source was associated with a lower rate of recurrent fever without affecting ICU transfer, adverse drug events, and death. Physicians should consider de-escalation prior to ANC recovery in the appropriate setting. Disclosures All authors: No reported disclosures.

Clonal Evolution and Devolution Following Chemotherapy in Adult Acute Myelogenous Leukemia.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2487-2487
Author(s):  
Brian Parkin ◽  
Peter Ouillette ◽  
Yifeng Li ◽  
Cheng Li ◽  
Kerby Shedden ◽  
...  
Keyword(s):  
Complete Remission ◽  
Gene Mutation ◽  
Induction Chemotherapy ◽  
Acute Myelogenous Leukemia ◽  
Conflicts Of Interest ◽  
Gene Mutations ◽  
Myelogenous Leukemia ◽  
Stable Gene ◽  
Paired Data ◽  
Acute Myelogenous

Abstract Abstract 2487 Introduction: Despite significant advances in the understanding of the biology of adult acute myelogenous leukemia (AML), overall survival remains poor due chiefly to the high rate of relapse after achieving complete remission as well as primary failure of induction chemotherapy. Efforts to further unravel the mechanisms leading to relapse and primary refractory disease are critical in order to guide the development of effective and durable treatment strategies for AML. To that end, this study seeks to elucidate the clonal relationship of AML in various disease phases. Methods: We employed SNP 6.0 array-based genomic profiling of acquired copy number aberrations (aCNA) and copy neutral LOH (cnLOH) together with sequence analysis of recurrently mutated genes to characterize paired AML genomes. We analyzed 28 AML sample pairs from patients that achieved complete remission with chemotherapy and subsequently relapsed (median remission duration 272 days [range 25 – 1249 days]) and 11 sample pairs from patients with persistent disease following induction chemotherapy. AML cell samples were isolated with a Ficoll gradient, negatively selected using Miltenyi microbead columns, and then further purified with flow cytometric cell sorting. Processed DNA isolated from highly purified AML blasts and paired buccal DNA was hybridized to Affymetrix SNP 6.0 arrays. aCNA were visually identified using the dChip program in paired data displays and corroborated by algorithmic lesion scoring, and cnLOH was detected using internally developed software. In addition, 11 genes known to be recurrently mutated in AML (CEBPA, DNMT3A, IDH1, IDH2, RUNX1, BCORL1, NPM1, NRAS, KRAS, FLT3 and TP53) were resequenced in all 39 presentation samples to identify somatically acquired mutations. Genes found mutated in individual AML cases were subsequently tested for the persistence of the mutation in paired samples. Results: For the 28 paired specimens in the relapsed cohort, comparison of aCNA and cnLOH occurrences, gene mutation patterns and karyotypes revealed 6 cases that carried no aCNA/cnLOH at either presentation or relapse, but at presentation carried at least 1 gene mutation, all of which but one were stable in relapse (1 case lost a RUNX1 mutation but carried a t(8;21) in both disease stages); 11 cases that were characterized by the presence of aCNA/cnLOH at presentation, of which 55% (6 of 11) gained additional aCNA/cnLOH at relapse; 6 cases without aCNA/cnLOH at presentation that gained aCNA/cnLOH at relapse, of which 2 concurrently lost a FLT3-ITD or CEPBA mutation; and 5 cases that carried no informative genomic events. For the 11 paired specimens in the persistent AML cohort, the same comparison revealed 2 cases without aCNA/cnLOH before or after chemotherapy and stable gene mutations; 5 cases with aCNA/cnLOH at presentation that carried the same genomic lesions and gene mutations before and after chemotherapy; 3 cases with aCNA/cnLOH present at enrollment that lost some but not all of these aCNA/cnLOH and gained none after initial induction therapy; and 1 additional case that lost a FLT3-ITD. Comparative analysis of these patterns demonstrates that relapsed AML invariably represents reemergence or evolution of an antecedent clone. Furthermore, all individual aCNA or cnLOH detected at presentation persisted at relapse indicating that this lesion type is proximally involved in AML evolution. Analysis of informative paired persistent AML disease samples uncovered at least two coexisting dominant clones of which at least one was chemotherapy sensitive and one resistant. Conclusion: This detailed genomic analysis supports the conclusion that incomplete eradication of AML founder clones rather than stochastic emergence of fully unrelated novel clones underlies AML relapse and persistence with direct implications for clinical AML research. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Thrombotic Microangiopathy with Skin Localization Secondary to Cytarabine-Daunorubicin Association: Report of a Case

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
S. Regragui ◽  
S. Amelal ◽  
S. Astati ◽  
M. Zine ◽  
N. Alami Drideb ◽  
...  
Keyword(s):  
Organ Failure ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Hemolytic Anemia ◽  
Induction Chemotherapy ◽  
Thrombotic Microangiopathy ◽  
Acute Myelogenous Leukemia ◽  
Myelogenous Leukemia ◽  
Organ Transplants ◽  
Thrombocytopenic Purpura ◽  
Acute Myelogenous

The thrombotic microangiopathy is a syndrome characterized by the combination of mechanical hemolytic anemia, peripheral thrombocytopenia, and organ failure of variable severity. In addition to the idiopathic form, several cases are identified as secondary to pregnancy, infections, disease systems, organ transplants, and cancer. Other forms are secondary to drugs including antimitotics. We report the case of a patient followed for acute myelogenous leukemia. She received induction chemotherapy combining daunorubicin and cytarabine, complicated by thrombotic thrombocytopenic purpura.

scholarly journals Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia

Blood ◽  
2013 ◽  
Vol 121 (21) ◽  
pp. 4287-4294 ◽  
Author(s):  
Heidi D. Klepin ◽  
Ann M. Geiger ◽  
Janet A. Tooze ◽  
Stephen B. Kritchevsky ◽  
Jeff D. Williamson ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Function ◽  
Induction Chemotherapy ◽  
Geriatric Assessment ◽  
Acute Myelogenous Leukemia ◽  
Trial Design ◽  
Myelogenous Leukemia ◽  
Key Points ◽  
Prediction Of Survival ◽  
Acute Myelogenous

Key Points Geriatric assessment, with a focus on cognitive and physical function, improves prediction of survival among older adults treated for AML. Use of geriatric assessment may inform trial design and interventions to improve outcomes for older adults with AML.

Sign in / Sign up

Export Citation Format

Share Document