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ACUTE MYELOID LEUKEMIA

Outcomes based on treatment setting in refractory acute myeloid leukemia and other high-grade myeloid malignancies

Leukemia volume 36, pages 1164–1166 (2022)Cite this article

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A significant proportion of patients with newly diagnosed acute myeloid leukemia fail to achieve a complete remission (CR) following initial induction therapy. At academic centers such patients must decide whether to stay for further treatment (“salvage”) or go back to their home and seek care in the community setting. Even if CR is not achieved, staying at an academic center to receive salvage may prove beneficial due to availability of clinical trials, more sophisticated supportive care, and/or closer follow-up. Although treatment at high-volume centers (usually academic) may prolong life in newly diagnosed AML, there have been few analyses in the salvage setting [1,2,3,4,5,6]. This prompted the following comparison of overall survival (OS) in refractory patients according to whether they stayed for subsequent treatment at our academic referral center, or returned to their home communities following initial induction chemotherapy failure.

We included adults ≥18 years of age with newly diagnosed AML (>20% blasts), or other myeloid neoplasms with 10–19% blasts, who were treated at the University of Washington/Fred Hutchinson Cancer Research Center (UW/FHCRC) between January 2012 and May 2018, and who failed to enter CR after either their first course of high- or intermediate-intensity chemotherapy, or after several cycles of low-intensity treatment (after which initial response assessment is commonly obtained). We excluded patients who died before they could begin reinduction therapy. The patients who remained at UW/FHCRC for additional treatment after induction failure are hereafter referred to as the “Academic” group; patients who did not stay after treatment failure are referred to as the “Community” group. In the Community group, care ranged from further AML-directed therapy, best supportive care, to hospice.

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Fig. 1: Kaplan–Meier curves for overall survival.

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Authors and Affiliations

  1. Hematology and Oncology Fellowship Program, University of Washington, Seattle, WA, USA

    Noam E. Kopmar

  2. Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Megan Othus

  3. Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA

    Kelda M. Gardner, Anna B. Halpern, Paul C. Hendrie, Roland B. Walter, Pamela S. Becker, Elihu H. Estey & Mary-Elizabeth M. Percival

  4. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Carole Shaw, Anna B. Halpern, Bart L. Scott, Paul C. Hendrie, Roland B. Walter, Pamela S. Becker, Elihu H. Estey & Mary-Elizabeth M. Percival

  5. Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA

    Bart L. Scott

  6. Department of Pathology, University of Washington, Seattle, WA, USA

    Roland B. Walter

  7. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Roland B. Walter

Authors
  1. Noam E. Kopmar
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  2. Megan Othus
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  3. Kelda M. Gardner
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  4. Carole Shaw
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  7. Paul C. Hendrie
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  8. Roland B. Walter
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  9. Pamela S. Becker
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  11. Mary-Elizabeth M. Percival
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Contributions

NEK, MBP, and EE designed the research; NEK, MBP, EE, and MO analyzed the data; NEK, MBP, and EE wrote the paper.

Corresponding author

Correspondence to Mary-Elizabeth M. Percival.

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Competing interests

ABH: Research Funding: Pfizer (1/2018–1/2019), Nohla Therapeutics (1/2018–1/2019), Jazz Pharmaceuticals (4/2020—present), Imago Pharmaceuticals, Novartis, Bayer, Tolero Pharmaceuticals consulting: agios pharmaceuticals.

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Kopmar, N.E., Othus, M., Gardner, K.M. et al. Outcomes based on treatment setting in refractory acute myeloid leukemia and other high-grade myeloid malignancies. Leukemia 36, 1164–1166 (2022). https://doi.org/10.1038/s41375-022-01509-0

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