Intensive Chemotherapy May Not Be Effective in MDS or AML After MDS

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Those receiving IC had a nonsignificant improvement in OS with 12.7 months, compared with 7 months among patients who did not receive IC.
Those receiving IC had a nonsignificant improvement in OS with 12.7 months, compared with 7 months among patients who did not receive IC.

Intensive chemotherapy (IC) may not lead to improved outcomes among patients with high-risk myelodysplastic syndrome (MDS) or acute myeloid leukemia after MDS (sAML), according to a study published in the Annals of Hematology.

Along with improvements in other therapies, evidence has shown that intensive chemotherapy is associated with low complete remission (CR) rates and poor overall survival among patients with MDS and sAML. This has led to a gradual reduction in its use as a treatment option over the past couple decades.

For this retrospective study, researchers analyzed the outcomes of 299 patients who received intensive chemotherapy at first diagnosis or at disease progression. Additionally, a matched pair analysis was performed comparing 96 patients receiving IC with 96 patients not receiving IC. Investigators sought to identify any predictive factors for treatment outcome, and to evaluate whether intensive chemotherapy still had a place in current treatment protocols.

Results showed that 50% of patients achieved complete remission. Factors associated with improved probability of achieving CR were less than 30% blast count in bone marrow, age younger than 65 years, presence of Auer rods, a 6-month or shorter duration of antecedent MDS, and IC administration after first diagnosis.  

Patients who received intensive chemotherapy had a nonsignificant improvement in OS with 12.7 months compared with 7 months among patients who did not receive IC. Factors associated with improved OS were less than 30% blast count in bone marrow, age younger than 60 years, presence of Auer rods, IC administration shortly after first diagnosis, and achieving complete remission.

A multivariable analysis showed that the factors significantly associated with median survival were CR achievement, presence of Auer rods, and percentage of blasts below or above 30%.

The rate of relapse was 63% among patients who received IC after a median of 9.9 months, and the median survival was 7.6 months.

The authors concluded that “the results of our analysis allow the conclusion that induction chemotherapy is not recommendable for patients with high-risk MDS or sAML, unless such therapy is needed as a “bridge,” leading to [allogeneic stem cell transplant] later on.”

Reference

  1. Schuler E, Zadrozny N, Blum S, et al. Long-term outcome of high risk patients with myelodysplastic syndromes or secondary acute myeloid leukemia receiving intensive chemotherapy [published online August 4, 2018]. Ann Hematol. doi: 10.1007/s00277-018-3466-7

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