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Causes of initial remission induction failure in patients with acute myeloid leukemia and myelodysplastic syndromes
P Anderlini1, M Luna, H M Kantarjian
1Department of Hematology, University of Texas MD Anderson Cancer Center, Houston, USA.
Abstract:
We analyzed 144 of 475 previously untreated patients with acute myeloid leukemia (AML, n = 87) and 'high-risk' myelodysplastic syndromes (MDS, n = 57) who failed to achieve a complete remission with fludarabine- and high-dose cytarabine-containing regimens between 1991 and 1994. The AML and MDS groups were comparable with regard to age, major prognostic indicators, supportive care received, type of antileukemia response and causes of death and were considered together. The causes of death of 118 evaluable patients were compared to a series of 123 AML initial remission induction failures previously reported from our institution. The induction failure rate was significantly lower (30 vs 43% P <0.001). We found a significant decrease in fatal infections (autopsied patients, P = 0.001) and a reduction in bacterial (autopsied and non-autopsied patients, P <0.005) but not fungal (non-autopsied patients, P = 0.93; autopsied patients P = 0.15) infections as causes of induction death. Pulmonary hemorrhage was twice as common in the present report (P < 0.005, with pulmonary hemorrhage almost three times as common as fatal cerebral hemorrhage. A comparison restricted to the AML patients in the present study yielded similar results. We conclude that the mortality profile in AML remission induction has undergone substantial changes at our institution since our last report, probably as a consequence of the introduction of new chemotherapy regimens and supportive care modalities.
Insights
New chemotherapy regimens and supportive care reduced induction failure and fatal infections in acute myeloid leukemia (AML) and high-risk myelodysplastic syndromes (MDS) patients. However, pulmonary hemorrhage increased as a cause of death.
Area of Science:
- Hematology
- Oncology
- Internal Medicine
Background:
- Previously untreated patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndromes (MDS) often fail initial remission induction.
- Understanding changes in mortality profiles is crucial for improving treatment outcomes.
Purpose of the Study:
- To analyze changes in causes of death among AML and high-risk MDS patients who failed induction therapy.
- To compare the mortality profile with previous reports from the same institution.
Main Methods:
- Retrospective analysis of 144 patients (87 AML, 57 MDS) treated between 1991-1994 who did not achieve complete remission.
- Comparison of causes of death in 118 evaluable patients with a historical cohort of 123 AML induction failures.
- Statistical analysis to determine significant differences in mortality causes.
Main Results:
- The overall induction failure rate decreased significantly (30% vs 43%, P <0.001).
- Fatal infections as a cause of induction death significantly decreased (P = 0.001), with a reduction in bacterial infections (P <0.005).
- Pulmonary hemorrhage became a more frequent cause of death, occurring twice as often (P < 0.005).
Conclusions:
- The mortality profile in AML remission induction has substantially changed, likely due to new chemotherapy regimens and supportive care.
- While fatal infections decreased, non-infectious causes like pulmonary hemorrhage have become more prominent.
- Further research into managing non-infectious complications is warranted.