AML de novo is different from AML from previous hematologic disease ie. MDS, PV, TE or myelofibrosis, secondary post chemo or RT for other malignancies, or in elderly when response can go from 70-80% down to 20 to 30%. Identification or personalized approach can show good prognosis in Inversion 16 chromosome, t(7;21), or molecular markers like NPM1 or CeBPa with normal cytogenetics. Multiple complex chromosome of FLT3ITD mutations identify bad ones.
primary AML, 70-80%.
second,such as transfrom MDS, lower, 30%.
not t(7;21),but t(8;21) means better.
It is very important to appreciate that one of the most important prognostic factors n AML is the intensity of treatment that can be delivered. If the treatment intensity is reduced (e.g. elderly) then the treatment response will be poor.
You also need to remember that "initial response" does not numerically translate into long term survival. If you give to an AML patient only induction therapy but no consolidation, life expectancy is generally less than a year. And the above referenced response rates are not what a lay person understands with the word "response". The 5-year leukemia-fre survival is unfortunately not at 70-80%. For select populations of patients who have a very low residual disease burden when they undergo hematopoietic stem cell transplantation, the odds are improved. [t(8:21), inv(16), or t(16;16)] are cytogenetically favorable groups (not t7;21)
Thank you Fatih, I agree with you that the initial response does not mirror the overall survival without disease. I just wanted to know how many patients show consistent reduction in blasts after the induction treatment.
Kind regards.
The term response rate probably is not the best way to define and evaluate efficacy of treatment in AML patients. Thus when other colleges say 70-80% response means COMPLETE responses which are those required for cure. The degree of responses in the remaining 20-30% has not always been fully evaluated and reported in all trails but include from those patients with a decrease in number of blasts but with more than 5% on bone marrow examination to those with a clear increase in leukemic cells reflecting primary refractory disease.
current approach to the management of patients diagnosed with AML is determined by a number of parameters, including age, performance status, co-morbidities,
aggressiveness of disease, prior leukemogenic exposures, prior marrow disease
including myelodysplasia, and certain prognostic cytogenetic/molecular
characteristics of the leukemic clone. Physicians use these factors in making
decisions regarding the type and aggressiveness of induction therapy, and whether the patient could be a candidate for aggressive consolidative measures such as stem cell transplantation.
Complete first remission (CR1) rates of up to 60-85% can be seen with this regimen, but unfortunately up to 60-80% of these patients will relapse.
The complete response rates in a large population of 400 leukemia patientes after induction in a University Hospital setting in Brasil are:
1.- younger than 60 y = 55%, older tha 60 y = 35%
2.- good cytogenetic profile = 80%
intermediate " " = 55%
bad " " = 49%
3.- secondary or not the novo leukemias = 34%
4.- primary refractory leukemias = 10 %
5.- relapses = 50%
What do you mean by an overall response?
Pedro Dorlhiac
For Primary AML after induction with 7+3 the Complete Remission (CR) rates are historically 50 to 70% overall. This varies widely depending on cytogenetics, molecular markers and age. For secondary AML the CR rates are around 20-40%.
Just want to add that for de novo AML in children the CR rates following induction exceeds 90% in most intensive treatment protocols.
The predictors for response depend on risk stratification which generally based on cytogenetic and molecular and patients can be categorized into favorable intermediate and unfavorable there is many risk stratification varies from one Group to another e.g SWOG ,MRC and refined MRC probably refined MRC is the best
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