scholarly journals Early related or unrelated haematopoietic cell transplantation results in higher overall survival and leukaemia-free survival compared with conventional chemotherapy in high-risk acute myeloid leukaemia patients in first complete remission

Leukemia ◽  
2009 ◽  
Vol 23 (4) ◽  
pp. 635-640 ◽  
Author(s):  
N Basara ◽  
◽  
A Schulze ◽  
U Wedding ◽  
M Mohren ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Complete Remission ◽  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Conventional Chemotherapy ◽  
Free Survival ◽  
Haematopoietic Cell ◽  
First Complete Remission ◽  
Acute Myeloid

Maintenance Treatment with Azacytidine for Patients with High Risk Myelodysplastic Syndromes or Acute Myeloid Leukaemia in Complete Remission after Intensive Chemotherapy.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 818-818 ◽  
Author(s):  
Michael Grövdal ◽  
Rasheed Khan ◽  
Anni Aggerholm ◽  
Petar Antunovic ◽  
Jan Astermark ◽  
...  
Keyword(s):  
High Risk ◽  
Complete Remission ◽  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Myelodysplastic Syndromes ◽  
Maintenance Treatment ◽  
Methylation Status ◽  
Intensive Chemotherapy ◽  
Cd34 Expression ◽  
Acute Myeloid

Abstract Patients with high-risk myelodysplastic syndromes (MDS) or acute myeloid leukaemia (AML) secondary to MDS may reach complete remission (CR) following intensive chemotherapy but the CR-duration is usually very short. Promoter hypermethylation of e.g. tumour suppressor genes is considered to be important in cancerogenesis and a negative risk factor for survival in patients with MDS. We designed a prospective clinical trial to assess the impact of methylation status on the outcome of induction chemotherapy and to evaluate the effect of maintenance treatment with 5-azacytidine (aza) on CR duration. Sixty patients with a median age of 68 years (54–83) with high risk MDS (n=23) or AML (n=37) following MDS were treated with standard doses of daunorubicin and ara-C. Standard prognostic variables, and methylation status of the P15ink4b (P15), E-cadherin (CDH) and Hypermethylated in Cancer 1 (HIC) genes were analyzed before treatment. Patients in CR were given low dose aza subcutaneously for 5 days/4 weeks until relapse. The CR rate was 40%; significantly lower in patients with high white blood cell counts (P=0.03) and high CD34 expression on bone marrow cells (P=0.02). While P15 status alone was not associated with CR rate (P=0.25) patients with CDH methylation showed a lower CR rate (P=0.008). Moreover, no patient with hypermethylation of all three genes achieved CR (P=0.03). CDH methylation retained its prognostic value in the multivariate analysis. Hypermethylation was associated with increased CD34 expression but not with blast count or cytogenetic risk group. Median duration of CR was 13 months (2 to +37) and 7/ 23 patients (30%) had a CR duration >20 months. Three of four patients with trisomy 8 had CR >20 months. The overall survival of patients reaching CR was 17 months (6 to +40). Methylation status before treatment did not correlate with CR duration. We demonstrate for the first time a significant impact of methylation status on the outcome of conventional chemotherapy in high-risk MDS and MDS-AML and propose that this variable should be further evaluated in prospective studies. CR duration is promising, with a substantial portion of patients showing durable responses.

Early Absolute Lymphocyte Count Is a Strong Predictor of Long Term Improved Survival in Childhood Acute Myeloid Leukaemia

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3553-3553
Author(s):  
Russell Keenan ◽  
Rebecca Williamson ◽  
Mark Caswell ◽  
Rahuman Salim ◽  
Helen Jane Campbell
Keyword(s):  
Overall Survival ◽  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Antigen Processing ◽  
Absolute Lymphocyte Count ◽  
Threshold Value ◽  
Event Free Survival ◽  
Free Survival ◽  
Acute Myeloid

Abstract Abstract 3553 The absolute lymphocyte count (ALC) has been shown to be a predictor of event free survival in the post transplant setting in many diseases including lymphoma, myeloma and leukaemia. (Porrata et al). Studies carried out at Alder Hey Childrens' Hospital, Liverpool in 2003 was the first one of its kind in looking at the ALC as a prognostic tool in the non-bone marrow transplantation setting in childhood leukaemia (Lomas et al, Hudson et al). The studies in acute myeloid leukaemia were small with short follow up. We present here the largest study of the prognostic significance of ALC in paediatric Acute Myeloid Leukaemia. We perfomed a retrospective single centre study involving 59 paediatric patients diagnosed with Acute Myeloid Leukaemia between 1985 and 2010 and treated using Medical Research Council AML 10, AML 12 and AML 15 protocols. Data was analysed for event free and overall survival. All 28 deaths occurred within 3 years. Follow up was 11 months to 27 years in the 31 survivors. A clear relationship was observed between patients with higher absolute lymphocyte counts and overall and event-free survival At 28 days post course 1 chemotherapy, using an ALC threshold value of 1.35 × 109/L, overall survival is 82% v 47% (p = 0.0336). The effect of the ALC diminishes with subsequent chemotherapy courses. At 28 days post course 2 chemotherapy using an ALC threshold value of 1.22 × 109/L, overall survival is 65% v 36% (p = 0.2952). At 28 days post course 4 chemotherapy using an ALC threshold of 0.67 × 109/L, overall survival is 69% v 50% p = 0.5983. We hypothesise that the higher ALC in the event-free patients, is due to tumour specific lymphocyte proliferation, causing clearance of low levels of leukaemia after chemotherapy. The chemotherapy acts to cause leukaemia cell death and antigen processing through macrophages. Chemotherapy causes tissue damage leading to upregulation of immunological danger signals with T and B lymphocyte expansion with specificity against the residual leukaemia cells. The reduced effect of the ALC predicting survival with each subsequent course of therapy may be a result of less leukaemia cells being present prior to each course. Less leukaemia cell death with each course results in less leukaemia antigen processing, presentation and lymphocyte expansion. If this hypothesis is confirmed it may be possible to carry out harvesting of tumour specific lymphocytes prior to chemotherapy with post chemotherapy add back to enhance the curative effect. Disclosures: No relevant conflicts of interest to declare.

Recombinant interleukin 2 for acute myeloid leukaemia in first complete remission: A pilot study

1990 ◽  
Vol 14 (11-12) ◽  
pp. 967-973 ◽  
Author(s):  
Donald Macdonald ◽  
Yinzheng Jiang ◽  
Andrea A. Gordon ◽  
Premini Mahendra ◽  
Ralph Oskam ◽  
...  
Keyword(s):  
Pilot Study ◽  
Complete Remission ◽  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Interleukin 2 ◽  
Recombinant Interleukin 2 ◽  
First Complete Remission ◽  
Acute Myeloid
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