Fate of Patients with Newly Diagnosed Acute Myeloid Leukemia Who Fail Primary Induction Therapy

• In a contemporary prospective chemotherapy trial for de novo acute myeloid leukemia, 150 of 589 eligible patients (25%) failed to achieve an initial remission.
• Twenty-three percent of these 150 patients were alive 4 years later.
• Among the 64 patients who received an allogeneic transplant, the four-year survival rate was 48% compared to 4% for the 86 who did not undergo transplantation.
• Among those transplanted, we could not detect a difference in outcome according to remission status, type of preparative regimen, or cytogenetic risk category.
• These results suggest that early HLA-typing and donor identification are important components of the initial therapy of AML.

The aim of this study was to describe the fate of patients with newly diagnosed acute myeloid leukemia (AML) who did not achieve an initial remission while being treated on a contemporary cooperative group trial. We analyzed the outcome of patients entered into S0106, a recently reported cooperative group trial for patients with newly diagnosed AML. A total of 589 eligible patients was treated, of whom 150 (25%) did not achieve a remission while on study and were available for further analysis. The 4-year survival rate for the entire cohort of 150 patients was 23%. Among the 64 patients who received an allogeneic hematopoietic cell transplant, the 4-year survival rate was 48% compared with 4% for the 86 patients who did not undergo transplantation. Among those transplanted, we could not detect a difference in outcome according to remission status, donor source, type of preparative regimen, or cytogenetic risk category. More than 20% of patients with newly diagnosed AML who fail induction therapy can still be cured, particularly if they are able to receive an allogeneic hematopoietic cell transplant. These results suggest that early HLA typing and donor identification are important components of the initial therapy of AML.