Outcomes of Intensive Treatment of Adult Acute Myeloid Leukemia Patients: A Retrospective Study From a Single Centre.

Abstract

Acute Myeloid Leukemia (AML) is a very aggressive cancer with difficult treatment and poor outcomes. The treatment of these patients is quite challenging due to various reasons including the need for extensive supportive care, and high cost of therapy. Reports on outcomes from India are few. We analyzed 93 adult patients (≥ 18years) with AML who were treated with curative intent between 2007 and 2014. Patients received daunorubicin at dose of 60-90mg/m2 and cytarabine 100mg/m2 during induction and consolidation with 3 courses of high dose cytarabine (1.5-3g/m2per dose for 6 doses per cycle). Only 4 patients underwent consolidation allogenic stem cell transplantation in first remission (CR1). The median age was 37 (18-66) years; males: 52%. Conventional cytogenetics (N = 63) showed 23% (N = 15), 56% (N = 35), 27% (N = 13) in good, intermediate risk and poor riskcategory respectively. FLT3-ITD was positive in 12/33 (36%) and NPM mutation in7/23 (30%). Daunorubicin dose was 60mg/m2 in 75% (N = 70) and 90mg/m2 in 25% (N = 23) patients. Induction mortality was 17% (16/93) [60mg/m2:19% (13/70), and 90mg/m2:13% (3/23); p = 0.39)]. Complete remission was achieved by 60% (56/93) [60mg/m2:53% (37/70), and 90mg/m2:83% (19/23); p = 0.09)]. The median overall survival was 9.2months and the actuarial survival at 2years was 30%. By univariate analysis, FLT3-ITD positivity, white cell counts higher than 100,000/mm3 at presentation, and use of lower dose of daunorubicin in induction were associated with poorer outcomes. Outcomes in adult AML are generally poor. Many patients with high risk disease don't receive allogenic transplantation in CR1. Increased availability of allogenic stem cell transplantation may help to improve outcomes.