| Objective To analyze the clinical and genetic risk factors of refractory or relapsed acute myeloid leukemia(AML) patients, and evaluate the efficacy of re-induction of chemotherapy. Methods A retrospective study of the clinical data of 296 newly diagnosed AML patients, including 89 refractory or relapsed cases was observed with clinical characteristics, and effect comparison of different re-induction chemotherapy schemes. Results Compared with the non-refractory or relapsed AML, age, complex karyotype and Fms-like tyrosine kinase 3-internal tandem duplications(FLT3-ITD)mutations are risk factors of relapsed or refractory AML(P<0.05).Seventy-eight refractory and relapsed AML patients received re-induction therapy. The overall response rate (complete remission +partial remission) was 44.9%. All re-induction regimens were roughly divided into three categories: using the initial induction scheme or using new induction scheme including some chemotherapeutics without cross-resistance(regimen A), using the induction regimen containing medium- or high-dose cytarabine(regimen B), and using priming regimen containing of G-CSF, cytarabine, aclacinomycin or homoharringtonine(regimen C).Their overall response rate respectively was 35.12%(13/37), 61.9%(13/21) and 45%(9/20). The overall response rate of regimen B was higher than regimen A(P<0.05). Conclusion Age, complex karyotype and FLT3-ITD mutation are important causes of relapsed or refractory AML. The difference of overall response rate was obvious among three different re-induction regimens. It is helpful to improve the overall response rate of re-induction therapy to use the regimen containing medium- or high-dose cytarabine, which is more suitable for young patients. The priming regimen suits for patients with poor tolerance to improve the overall response rate.Initial induction chemotherapy is critical for patients with newly diagnosed de novo acute myeloid leukemia(AML). The aim of the present study was to analyze the factors affecting the outcome of AML patients who failed to initial chemotherapy. We retrospectively analyzed clinical data of 311 adults with de novo AML. Compared with 179 patients showing complete remission(CR), 132 patients who failed to achieve CR were older, poorer prognostic stratification, higher proportion of FMS-like tyrosine kinase 3-internal tandem(FLT3-ITD)mutation, higher expression rates of CD9, lower expression rates of c MPO and CD64, poorer overall survival(OS). The 2-year OS rate of the non-CR groups was inferior to that of the CR groups(28.3% vs. 53.3%, P < 0.001). However, there was no dramatic difference in 2-year OS rate between initial and re-induction chemotherapy if patients achieved a same remission status. The 2-year OS rate significantly improved following allogeneic hematopoietic stem cell transplantation(allo-HSCT) in patients who failed to initial treatment. The survival of patients with similar remission status was affected by FLT3-ITD mutation instead of CD9+ expression. Initial induction failure or poorer prognostic stratification seriously affected the survival of patients with de novo AML. Allo-HSCT is an alternative strategy to improve the survival of patients resistant to initial treatment.To analyze the possible predictive factors of re-induction therapeutic response, we retrospectively analyze 109 patients who failed to the primary induction therapy and received re-induction chemotherapy. 67 of the 109 patients(61.5%) failed to re-induction therapy. Non complete remission(CR) patients had significant higher bone marrow(BM) blast percentage and white blood cell(WBC) count before re-induction therapy?lower BM blast declining rate after primary induction chemotherapy. Both prognostic stratification and BM blast declining percentage after primary induction chemotherapy were independent factors affecting the CR rate of re-induction. Compared patients who failed to re-induction, patients in CR status had a better 2-year overall survival(OS) rate(52.4%vs. 17.5%, P < 0.01). 21 of 67 patients who failed to re-induction therapy received allogeneic hematopoietic stem cell transplantation(allo-HSCT). 2-year OS rate of these patients was higher than that of all patients(79.8% vs. 31.1%, P =0.000). Cox univariate regression analyses showed that the factors affecting OS included prognostic stratification, BM blast declining percentage after primary induction chemotherapy, WBC count before re-induction, remission status of re-induction and allo-HSCT. Multivariate analyses indicated that independent factors affecting OS were WBC count before re-induction therapy, remission status of re-induction and allo-HSCT. The results show that the re-induction therapeutic effect was a very important factor affecting OS. Allo-HSCT is a valuable salvage treatment measures for de novo AML patients who failed the re-induction. |
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