Treatment of acute myeloid leukemia in adults in the period 2008–2011 at the University medical centre Ljubljana

Abstract

Background: Retrospective analyses of unselected patients with acute myeloid leukaemia (AML), treated at individual centres, provide an estimate of treatment success in real world, in contrast to artificially designed conditions in clinical trials. We analysed the treatment outcome of adult patients with AML at the University Medical Centre of Ljubljana over the last four years. Results: From year 2008 to 2011, 222 patients with AML were treated at our centre. Out of the 222 treated patients, 19 patients had acute promyelocytic leukaemia (APL) and they received a combination of tretinoin and anthracycline based chemotherapy. Four patients died in the period of induction therapy, while the remaining patients reached molecular remission, which still lasts. In the group of 203 non-APL patients, 129 patients (of these 76 younger and 53 older than 59 years) received intensive chemotherapy. Non-intensive treatment was given to 74 patients. The intensive treatment included daunorubicin-cytarabine- based induction therapy (DA3+10). In 22 % of younger patients the time from diagnosis to the beginning of intensive treatment lasted more than 5 days. The percentage of early deaths (less than 33 days after the beginning of treatment) was 12 % for younger, and 19 % for older patients. The remission rate was 67 % in younger and 47 % in older patients. The estimated median of overall survival was 13 months and relapsefree survival was 12.5 months. Three-year survival rate was 31 %. Allogeneic stem-cell transplantation was performed in 36 patients; in 10 of these patients transplantation was induction treatment. Remission was achieved in a half of the patients , 8 patients died and of these only 2 survived more than a year. Allogeneic stem cell transplantation was a part of consolidation treatment in 26 patients. In four cases AML relapsed and 10 patients died (38 %). Relapse of the disease was the cause of death in two cases only . Conclusions: The remission rate in our study is comparable with the reports of several randomized trials. For survival analysis, if we are critical, the duration of follow-up in our study might be too short. Suggested measures for the improvement of treatment outcome are: once a diagnosis of APL is suspected, treatment with tretinoin (and blood products) should be started immediately, in younger patients with AML the time from diagnosis to treatment initiation should be under 5 days, patient-specific and leukaemia-associated factors should be analysed carefully before the treatment decisions, especially in older patients.