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Results in the Treatment With Chemotherapy in Acute Myeloid Leukemias. Experience of 20 Years

Reviewer: Neha Vapiwala, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: March 22, 2007

Presenter: Hernández, C.
Presenter's Affiliation: Hospital Hermanos Ameijeiras, Cuba
Type of Session: Scientific

Background

• Acute myeloid leukemia (AML) represents 80% of the total number of acute leukemias that affect the adult Cuban population. Yet despite this high prevalence, its prognosis remains very unfavorable.
• This paper was aimed at showing the experience accrued by this Cuban hospital, describing the presentation and treatment of this disease. Of note, the results reported here are with the use of chemotherapy alone, as this is a setting where allogeneic stem cell transplants are not in routine use.

Materials and Methods

• This is a single institution, retrospective study of patients with AML
• First, 193 cases of AML that were diagnosed and treated by the Hematology Service at Hospital “Hermano Ameijeiras” over a 20-year period were identified.
• Then, their pathologic and clinical features were characterized.

Results

• Mean age: 42.7 years
• Most frequent FAB subtype was M2.
• Complete remission index:
  • Non-M3 AML (any type other than Acute Promyelocytic Leukemia):
  • 45.5% for all ages
  • 60.4% for < 60 years old
  • M3 AML (Acute Promyelocytic Leukemia):
  • 75% for all ages
• Overall Survival (5 years):
  • Non-M3 AML
  • 8.9% < 60 years
  • 0% >60 years
  • M3 AML:
  • 40% for all ages
• Complication-free survival (5 years):
  • Non-M3 AML
  • 16.2% for all ages
  • M3 AML
  • 62% for all ages

Author's Conclusions

• This is a confirmatory study as it demonstrates a poor outcome for patients with AML when chemotherapy is used as the sole treatment. These results are similar to other studies.
  
• The exception to this generally poor prognosis disease are patients with the M3 subtype of AML.

Clinical/Scientific Implications

• AML is an aggressive disease and is widely recognized as difficult to cure. In North America and Europe, the goal of chemotherapy is to put patients into remission, with an ultimate plan to perform allogeneic stem cell transplantation, with or without the use of total body irradiation for conditioning. The phenomenon known as “graft versus leukemia” is thought to be a predominant mechanism for the efficacy of transplantation, in those cases where it works.
• This study shows the “natural history” of AML when chemotherapy is the only modality used for treatment. It confirms that M3 AML is a more favorable subtype that can potentially be cured with chemotherapy. Typically, it is treated with a compound known as all-trans retinoic acid.
• In non-M3 AML subtypes, younger patients can potentially be cured with chemotherapy alone, although the cure rate is still dismal, suggesting the critical need for additional therapy in the standard regimen following chemotherapy.