Prognostic impact of re-induction chemotherapy and age-adapted consolidation strategy in AML

Results from a retrospective study evaluating the impact of re-induction chemotherapy and age-adapted consolidation strategy on relapse-free survival (RFS), overall survival (OS), and post-transplant survival in 279 patients with acute myeloid leukemia (AML) were published in Blood Cancer Journal by Bolarinwa et al. Re-induction was required to achieve complete remission (CR) or CR with incomplete hematologic recovery (CRi) in 72 patients based on residual bone marrow blasts on Day 14 (n = 53) or Days 21–28 (n = 15), persistent extramedullary disease (n = 2), or circulating blasts (n = 2). Consolidation strategies consisted of an anthracycline-based regimen (n = 84), high-dose cytarabine (HiDAC; n = 99), or intermediate-dose cytarabine (IDAC; n = 58).

Key data: At median transplant-censored follow-up of 26 months, median RFS was 14 months in patients requiring re-induction vs 22 months in those who did not (p < 0.01), while median OS was 37 months vs 106 months, respectively (p < 0.01). In multivariable analysis, the need for re-induction to achieve CR/CRi independently predicted relapse (hazard ratio [HR], 1.9; p = 0.01) and inferior OS (HR, 2; p = 0.02). Among patients who underwent allogeneic stem cell transplantation (allo-HSCT), median post-transplant survival did not differ between those requiring re-induction and those who did not (61 months vs 76 months; p = 0.6). Among patients aged ≥65 years, IDAC (n = 36) was associated with longer median RFS (23 months vs 8 months; p < 0.01) and OS (40 months vs 12 months; p < 0.01) vs the anthracycline-based regimen (n = 25) as the first consolidation treatment cycle. Among patients aged <65 years, median RFS (p = 0.3) and median OS (p = 0.07) did not differ across all consolidation strategies, although median OS was superior with the anthracycline-based regimen (not reached [NR]) vs HiDAC (85 months; p = 0.02).

Key learning: In this study, the need for re-induction to achieve CR/CRi was independently associated with shorter RFS and OS, but not with post-allo-HSCT survival, in patients with AML, supporting early transplant consideration in these patients. First-cycle consolidation outcomes varied by age, supporting further evaluation of age-adapted consolidation strategies in AML.