Day 15 bone marrow driven double induction in young adult patients with acute myeloid leukemia: feasibility, toxicity and therapeutic results.
Résumé
The strategy named double induction (DI) in acute myeloid leukemia (AML) consists of two courses of chemotherapy irrespective of the degree of cytoreduction in the bone marrow after the first course, unless severe complications prohibit its application. We describe treatment results from a series of 33 patients in whom DI was adopted only after demonstration of persistence of more than 10% blast cells at day 15 (D15) examination of bone marrow. All patients received as induction idarubicin, cytarabine and etoposide. As second induction, we administered the combination of fludarabine, intermediate dose cytarabine and G-CSF. The median blast count at D15 was 30 (15-90). Overall, 30 out of 33 patients were judged as eligible to receive DI, reasons for exclusion being in all cases active infection in the context of severe pancytopenia. Nineteen patients (63%) had unfavorable karyotype and 11 (37%) normal karyotype; 7 of these had FLT3/ITD mutation. Overall, CR was achieved in 20/30 patients (67%), while 8 patients (27%) were refractory and 2 died of infectious complications. All refractory patients had unfavorable cytogenetics. All patients achieving CR were programmed to receive allogeneic stem cell transplantation (allo-SCT), which was actually performed in 11 patients. Our study suggest that D15 driven DI represents a feasible and effective therapeutic strategy in young adult AML patients, improving therapeutic results and not compromising feasibility of allo-SCT. As compared to conventional DI, it offers the potential to avoid unnecessary toxicity in a consistent proportion of patients.
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