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England JT, Saini L, Hogge D, Forrest D, Narayanan S, Power M, Nevill T, Kuchenbauer F, Hudoba M, Szkotak A, Brandwein J, Sanford D. Day 14 Bone Marrow Evaluation During Acute Myeloid Leukemia Induction in a Real-world Canadian Cohort. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e427-e436. [PMID: 32201130 DOI: 10.1016/j.clml.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The 2017 National Comprehensive Cancer Network guidelines for acute myeloid leukemia have recommended performing bone marrow (BM) aspiration and BM trephine biopsy (BMTB) 14 to 21 days after starting induction therapy (commonly referred to as "day 14 [D14] marrow"). Those who do not achieve a hypoplastic marrow, with cellularity < 20% and blasts < 5%, are recommended to undergo 2-cycle induction (2CI). We performed a retrospective analysis to determine the impact of D14 BM characteristics in predicting for remission, association with overall survival (OS), and the effect of 2CI according to the D14 BM results. PATIENTS AND METHODS Patients aged 18 to 70 years undergoing induction therapy with standard "7 + 3" regimens were included. D14 cellularity was determined from BMTB samples and the blast percentage was assessed by morphology on BM aspiration and BMTB samples. The outcomes evaluated included the rates of complete remission (CR) and OS. RESULTS A total of 486 patients with results from D14 BM evaluation were included in the present study. On multivariate analysis, cytogenetic risk and D14 blasts < 5% were predictive of CR/CR with incomplete count recovery (P < .001). Cytogenetic risk (P < .001), age < 60 years (P = .001), and D14 blasts < 5% (P = .045) predicted for OS. 2CI was performed in 131 patients (27%). Patients with hypocellular D14 BM but residual blasts (n = 106) underwent 2CI in 46% of cases, with improved remission rates (43.9% vs. 72.0%; P = .004) but no difference in OS. CONCLUSIONS The results from D14 BM evaluations are predictive of subsequent remission and OS. Our findings did not show a survival benefit with D14 BM-driven 2CI.
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Affiliation(s)
- James T England
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lalit Saini
- Division of Hematology, Department of Medicine, Western University, London, ON, Canada
| | - Donna Hogge
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Donna Forrest
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sujaatha Narayanan
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Maryse Power
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Nevill
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Florian Kuchenbauer
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Monika Hudoba
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Artur Szkotak
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Joseph Brandwein
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - David Sanford
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Pluta A, Robak T, Brzozowski K, Stepka K, Wawrzyniak E, Krawczynska A, Czemerska M, Szmigielska-Kaplon A, Grzybowska-Izydorczyk O, Nowicki M, Stelmach P, Kuydowicz M, Gromek T, Hus M, Helbig G, Grosicki S, Bodzenta E, Razny M, Wojcik K, Bolkun L, Kloczko J, Knopinska-Posluszny W, Piekarska A, Hellman A, Sobas M, Wrobel T, Patkowska E, Lech-Maranda E, Warzocha K, Holowiecki J, Giebel S, Wierzbowska A. Early induction intensification with cladribine, cytarabine, and mitoxantrone (CLAM) in AML patients treated with the DAC induction regimen: a prospective, non-randomized, phase II study of the Polish Adult Leukemia Group (PALG). Leuk Lymphoma 2019; 61:588-603. [PMID: 31661339 DOI: 10.1080/10428194.2019.1678151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We present the results of a prospective, non-randomized phase 2 trial in which 253 AML patients (pts) under 60 years old received DAC (Daunorubicin + AraC + Cladribine) as first induction followed by CLAM (Cladribine + AraC + Mitoxantrone) as early second induction on day 16 based on bone marrow (BM) blasts on day 14 (D14). The CR/CRi rate after a single course of DAC was 83% for pts with D14 BM blasts less than 10%. Forty-six pts had >10% BM blasts on D14, of whom 35 received CLAM with rates of CR/CRi 60% and early death (ED) 23%. The remaining 11 pts were not fit to receive CLAM, with rates of CR/CRi 28%, PR 18%, and ED 18%. Median OS was 7.2 versus 7.5 months, respectively. The overall CR/CRi rate was 77% after the first induction, with final CR/CRi rate 80% after DAC reinduction for pts who achieved PR with initial DAC course. CLAM used as early second induction might improve CR/CRi rates for younger AML pts with poor early response to DAC induction, but may be associated with higher mortality.
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Affiliation(s)
- Agnieszka Pluta
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Kamil Brzozowski
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Konrad Stepka
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Ewa Wawrzyniak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Anna Krawczynska
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | | | | | | | - Mateusz Nowicki
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Piotr Stelmach
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Marta Kuydowicz
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Tomasz Gromek
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Marek Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Helbig
- Department of Hematology and BMT, Medical School of Silesia, Katowice, Poland
| | - Sebastian Grosicki
- Department of Cancer Prevention, School of Public Health, Medical University of Silesia, Katowice, Poland
| | - Ewa Bodzenta
- Department of Hematology, Municipal Hospital, Chorzow, Poland
| | - Małgorzata Razny
- Hematology Department, Rydygier Memorial Hospital, Krakow, Poland
| | - Karol Wojcik
- Hematology Department, Rydygier Memorial Hospital, Krakow, Poland
| | - Lukasz Bolkun
- Department of Hematology, Medical University Hospital, Bialystok, Poland
| | - Janusz Kloczko
- Department of Hematology, Medical University Hospital, Bialystok, Poland
| | | | - Agnieszka Piekarska
- Department of Hematology, Transplantation Medical University of Gdansk, Gdansk, Poland
| | - Andrzej Hellman
- Department of Hematology, Transplantation Medical University of Gdansk, Gdansk, Poland
| | - Marta Sobas
- Department of Hematology, Blood Neoplasm and Bone Marrow Transplantation, Wroclaw, Poland
| | - Tomasz Wrobel
- Department of Hematology, Blood Neoplasm and Bone Marrow Transplantation, Wroclaw, Poland
| | - Elzbieta Patkowska
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.,Department of Hematology and Transfusion Medicine, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ewa Lech-Maranda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.,Department of Hematology and Transfusion Medicine, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Krzysztof Warzocha
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Institute - Cancer Center, Gliwice Branch, Gliwice, Poland
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Institute - Cancer Center, Gliwice Branch, Gliwice, Poland
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Refaei M, Radhwi O, Sandhu I, Brandwein J, Sun HWL, Saini L. A strategy of Day14 bone marrows and early intervention is not superior to a strategy of noDay14 bone marrows and delayed intervention in patients with acute myeloid leukemia. Leuk Lymphoma 2019; 60:1749-1757. [PMID: 31043109 DOI: 10.1080/10428194.2018.1543878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We conducted a retrospective study of 364 acute myeloid leukemia patients treated using a Day14 or a noDay14 strategy. Under the Day14 strategy, patients received an interim marrow at 7-10 days following chemotherapy and, in case of residual disease, received immediate reinduction chemotherapy. Under the noDay14 strategy patients were only evaluated at end-of-induction (EOI). Overall induction mortality was higher in the Day14 cohort (8.3 vs. 3.6%, p = .12) but rates of remission (75.4 vs. 83%, p = .13) and refractory disease (14.3 vs. 13.4%, p = .87) at EOI were similar in the Day14 and noDay14 cohorts as were relapse rates (37.9% vs. 34.3%, p = .616), median relapse-free survival (14.8 vs. 15 months, p = .658) and median overall survival (25.3 vs. 37.2 months, p = .264). In multivariate analysis, the use of a Day14 strategy did not impact outcomes suggesting that a Day14 strategy is not superior to a noDay14 strategy.
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Affiliation(s)
- Mohammad Refaei
- a Department of Medicine , University of Alberta , Edmonton , Canada
| | - Osman Radhwi
- a Department of Medicine , University of Alberta , Edmonton , Canada
| | - Irwindeep Sandhu
- a Department of Medicine , University of Alberta , Edmonton , Canada
| | - Joseph Brandwein
- a Department of Medicine , University of Alberta , Edmonton , Canada
| | - Hao Wei Linda Sun
- a Department of Medicine , University of Alberta , Edmonton , Canada
| | - Lalit Saini
- a Department of Medicine , University of Alberta , Edmonton , Canada
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Shen Y, He A, Wang F, Bai J, Wang J, Zhao W, Zhang W, Cao X, Chen Y, Liu J, Ma X, Chen H, Feng Y, Yang Y. Granulocyte colony stimulating factor priming chemotherapy is more effective than standard chemotherapy as salvage therapy in relapsed acute myeloid leukemia. Med Clin (Barc) 2017; 151:339-344. [PMID: 29292108 DOI: 10.1016/j.medcli.2017.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 10/07/2017] [Accepted: 11/02/2017] [Indexed: 01/02/2023]
Abstract
INTRODUCTION AND OBJECTIVE To improve the complete remission (CR) rate of newly diagnosed acute myeloid leukemia (AML) patients and alleviate the severe side effects of double induction chemotherapy, we combined a standard regimen with granulocyte colony-stimulating factor (G-CSF) priming chemotherapy to compose a new double induction regimen for AML patients who failed to achieve CR after the first course. PATIENTS AND METHODS Ninety-seven patients with AML who did not achieve CR after the first course of standard chemotherapy were enrolled. Among them, 45 patients received G-CSF priming combined with low-dose chemotherapy during days 20-22 of the first course of chemotherapy, serving as priming group, 52 patients were administered standard chemotherapy again, serving as control group. RESULTS Between the two groups there were no differences in the French-American-British (FAB) classification, risk status, the first course of chemotherapy, blood cell count or blasts percentage of bone marrow before the second course. But the CR rate was significantly higher and the adverse effect was much lower in the priming group than the control group. Cox multivariate regression analysis showed that WBC level before the second course and the selection of the second chemotherapy regimen were two independent factors for long survival of patients. DISCUSSION These results elucidate that standard chemotherapy followed by G-CSF priming new double induction chemotherapy is an effective method for AML patients to improve CR rate and reduce adverse effects.
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Affiliation(s)
- Ying Shen
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Aili He
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China; National-Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, 710004 Xi'an, Shaanxi, China
| | - Fangxia Wang
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Ju Bai
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Jianli Wang
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Wanhong Zhao
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Wanggang Zhang
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Xingmei Cao
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Yinxia Chen
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Jie Liu
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Xiaorong Ma
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Hongli Chen
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Yuandong Feng
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China
| | - Yun Yang
- Department of Hematology, Second Affiliated Hospital, Xi'an Jiaotong University, 710004 Xi'an, Shaanxi, China.
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Peng N, Wei H, Lin D, Zhou CL, Liu BC, Wang Y, Liu KQ, Gong BF, Wei SN, Zhang GJ, Liu YT, Gong XY, Qiu SW, Mi YC, Wang JX. [Prognostic significance of flow cytometric minimal residual disease in acute myeloid leukemia during aplasia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:767-771. [PMID: 29081193 PMCID: PMC7348354 DOI: 10.3760/cma.j.issn.0253-2727.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the impact of minimal residual disease (MRD) by multiparameter flow cytometry (MPFC) during aplasia on efficacy and prognosis of de novo acute myeloid leukemia (AML) (non M(3)) patients. Methods: The MRD data by 8-color MPFC during aplasia (day 14-15 of induction therapy) in 85 de novo AML (non M(3)) patients and the MRD impact on efficacy and prognosis were retrospectively analyzed. Results: Data of 85 patients, including 42 males (49.4%) and 43 females (50.6%) , were collected, with a median age of 35 (15-54) years. The median MRD by MPFC during aplasia was 0.58% (0-81.11%) , and 70 (82.4%) patients achieved complete remission (CR) after first induction chemotherapy. The cutoff of MRD by receiver operating characteristic (ROC) analysis was 2.305% (Se= 0.867, Sp=0.800) . The CR rate after one course was significantly higher in patients with MRD<2.305% [96.6% (56/58) ]than in patients with MRD≥2.305%[51.9% (14/27) ] (χ(2)=22.348, P<0.001) ; no significant difference with respect to relapse-free survival rate (χ(2)=1.08, P=0.299) or overall survival rate (χ(2)=0.42, P=0.516) could be demonstrated for the comparison of the two groups. Multivariates analysis showed MRD divided by 2.305% was the only independent prognostic factor for CR after one course (OR= 21.560, 95% CI 4.129-112.579, P<0.001) . Conclusion: Flow cytometric MRD divided by 2.305% during aplasia could be a predictor of efficacy after first induction therapy in AML patients.
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Affiliation(s)
- N Peng
- Institute of Hematology & Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
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Souto Filho JTD, Loureiro MM, Pulcheri W, Morais JC, Nucci M, Portugal RD. Evaluation of bone marrow aspirates in patients with acute myeloid leukemia at day 14 of induction therapy. Diagn Pathol 2015; 10:122. [PMID: 26205005 PMCID: PMC4513973 DOI: 10.1186/s13000-015-0365-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/15/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Early assessment of response to chemotherapy in acute myeloid leukemia may be performed by examining bone marrow aspirate (BMA) or biopsy (BMB); a hypocellular bone marrow sample indicates adequate anti-leukemic activity. We sought to evaluate the quantitative and qualitative assessment of BMA performed on day 14 (D14) of chemotherapy, to verify the inter-observer agreement, to compare the results of BMA and BMB, and to evaluate the impact of D14 blast clearance on the overall survival (OS). METHODS A total of 107 patients who received standard induction chemotherapy and had bone marrow samples were included. BMA evaluation was performed by two observers using two methods: quantitative assessment and a qualitative (Likert) scale. ROC curves were obtained correlating the BMA quantification of blasts and the qualitative scale, by both observers, with BMB result as gold-standard. RESULTS There was a significant agreement between the two observers in both the qualitative and quantitative assessments (Kw = 0.737, p < 0.001, and rs = 0.798, p < 0.001; ICC = 0.836, p < 0.001, respectively). The areas under the curve (AUC) were 0.924 and 0.946 for observer 1 and 0.867 and 0.870 for observer 2 for assessments of the percentage of blasts and qualitative scale, respectively. The best cutoff for blast percentage in BMA was 6% and 7% for observers 1 and 2, respectively. A similar analysis for the qualitative scale showed the best cutoff as "probably infiltrated". Patients who attained higher grades of cytoreduction on D14 had better OS. CONCLUSIONS Evaluation of D14 BMA using both methods had a significant agreement with BMB and between observers, identifying a population of patients with poor outcome.
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Affiliation(s)
- João Tadeu D Souto Filho
- University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil.
- Faculdade de Medicina de Campos, Campos dos Goytacazes, RJ, Brazil.
- Instituto Federal de Educação, Ciência e Tecnologia Fluminense, Campos dos Goytacazes, RJ, Brazil.
| | - Monique M Loureiro
- University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil.
| | - Wolmar Pulcheri
- University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil
| | - José Carlos Morais
- University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil
| | - Marcio Nucci
- University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil.
| | - Rodrigo D Portugal
- University Hospital, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255, Sala 4A 12, Rio de Janeiro, 22251-030, RJ, Brazil.
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Abstract
The outlook for patients with acute myeloid leukaemia has improved in the past 30 years. Unlike other cancers, much of this progress is attributable to refinement of supportive treatment, rather than the introduction of new drugs. New antibacterial and antifungal agents, antiemetics, and improved transfusion support have decreased the rate of early death, and morbidity and mortality from allogeneic stem cell transplantation has been substantially reduced. However, more than half of young adult patients and about 90% of older patients still die from their disease. Refractoriness to initial induction treatment and, more frequently, relapse after complete remission, are still the main obstacles to cure. Accordingly, new treatment approaches with mechanisms of action different from those of conventional chemotherapy are needed. Our knowledge of the various chromosomal and molecular abnormalities implicated in the pathogenesis of the many subtypes of the disease has greatly expanded; as a result, clinical research is moving towards the investigation of new non-cytotoxic agents in combination with chemotherapy. The goal is to target the molecular abnormalities identified at diagnosis; however, several aberrations can coexist in subclones of acute myeloid leukaemia, making the disease less likely to be inhibited by a single agent.
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MESH Headings
- Adult
- Age Factors
- Age of Onset
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Bone Marrow Transplantation/methods
- Bone Marrow Transplantation/mortality
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Hematopoietic Stem Cell Transplantation/methods
- Hematopoietic Stem Cell Transplantation/mortality
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/therapy
- Prognosis
- Risk Assessment
- Severity of Illness Index
- Sex Factors
- Survival Analysis
- Transplantation, Autologous
- Transplantation, Homologous
- Treatment Outcome
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Affiliation(s)
- Felicetto Ferrara
- Division of Haematology and Stem Cell Transplantation Unit, Naples, Italy.
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