Resumen

Introduction: Acute myeloid leukemia (AML) comprises a group of disorders with different biologic characteristics. Unfortunately, despite knowledge improvements, long-term survival benefits are not reported. Objective: We aimed to describe characteristics of adults with AML attended in a third level hospital at Mexico City, to assess treatment responses, complications and to evaluate survival-related factors. Material and methods: Cohort study. Between October 2003 and July 2008, patients with newly diagnosed AML were evaluated (acute promyelocytic leukemia was excluded). Treatment protocols included: 7+3, high doses of cytarabine and autologous stem cell transplant as consolidation therapy. Results: Fifty-three patients were included in the present study. Median age at diagnosis was 44 years (ranging from 15-79). At diagnosis tumor lysis syndrome was present in 4 out of 53 (7.5%). Abnormal liver test function was detected in 3 out of 51 (5.9%) and hyperleukocytosis was present in 8 of 53 (15.1%). Cytogenetic data was available in 46 patients and informative karyotype was reported in 28/46 (60.8%). While 12 out of 28 (42.8%) exhibited a poor prognosis karyotype, 16/28 (57.1%) an intermediate risk and none was favorable. Two patients were lost during follow-up, 7 patients did not receive chemotherapy with intention to cure, and 1 died at diagnosis. Fortythree patients received 3+7 and 13.9% died during marrow aplasia. Complete remission was achieved in 27/43 (62.7%) and 10/43 (23.2%) were refractory to treatment. A second induction attempt was required in 39.5% (17/43). Median disease free survival (DFS) was 491days (366-615), with a median follow-up of 993 days (105-1744). The median overall survival (OS) was 531 days (312-749). Aplasia-related mortality decreased in the current cohort when compared to the historical one (13.9 vs. 37%; p = 0.09). Conclusions: Long-term survival in AML group remains poor despite improvements in diagnosis, classification, and treatment. At our institution, it is required to improve induction regimens and to achieve a better cytogenetic analysis in order to accurately define the group of patients that could benefit from stem cell transplant.

Palabras clave: Acute myeloid leukemia. 7+3 protocol. High doses of cytarabine. Autologous bone marrow transplant.

2013-07-24   |   632 visitas   |   Evalua este artículo 0 valoraciones

Vol. 62 Núm.2. Marzo-Abril 2010 Pags. 100-108 Rev Invest Clin 2010; 62(2-ENGLISH)