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Response to Induction Chemotherapy Predicts Survival in AML: A Single Centre Experience from North India

Soniya Nityanand, Professor & Head, Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareli Road. Lucknow, Uttar Pradesh 226014, India. , Anshul Gupta1 , Akanksha Garg2 , Akhilesh Sharma3 , Ashish Mishra4 , Sanjeev5 , Soniya Nityanand6

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Indian Journal of Cancer Education and Research 6(2):p 125-134, July-Dec 2018. | DOI: DOI: http://dx.doi.org/10.21088/ijcer.2321.9815.6218.2

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Abstract

  Aim: The present study was carried out to analyze the  various patient related (e.g. age, sex, performance status), disease related (white blood cell count, cytogenetic and molecular mutational status)and treatment related (delay in treatment initiation and response to induction chemotherapy)variables as predictors of outcome in acute myeloid leukemia (AML) patients presenting to a tertiary care center in North India. Materials and Methods: Thedata of all newly diagnosed de-novo AML patients who presented to our center from January 2015 to December 2017 and opted for chemotherapy was correlated with treatment outcome. Results: Sixty eight patients underwent induction chemotherapy during the study period. Sixteen (23.5%), 49 (72.1%) and 3 (4.4%) were in the favorable, intermediate and adverse risk groups, respectively. Fifteen (22%), 8 (11.7%) and 11 (16.1%) patients were positive for AML-ETO, NPM1, FLT3 mutations (3 patients had FLT3 D835 mutations), respectively. Exon 17 c-kit mutations were seen in 10 (14.7%) patients. We did not observe any exon 8 c-kit mutations in our cohort of patients. Biallelic CEBPA mutations were seen in 6 patients (8.8%). Following induction chemotherapy, 26 (38.2%) patients attained complete remission (CR), 20 (29.4%) achieved incomplete CR (platelet count<100 x 109/L) and 22 (32.4%) were refractory to induction therapy. There were only 3 (4.4%)  induction deaths.High TLC was associated with FLT3 mutations (p=0.03) and presence of extra medullary disease correlated with AML-ETO (p=0.02) and c-KIT mutations (p=0.02). There was statistically significant correlation of FLT3-ITD mutation positive patients with risk of relapse (p= 0.001). The 2 yr Overall survival (OS) and Event free survival (EFS) were 39.6% and 22.8%,
respectively. In a multivariate analysis, the performance  status (PS) and post induction remission status independently predicted survival.

Conclusion: Thus our data highlights that PS and post induction remission status translates into better OS. 

Keywords: Acute Myeloid Leukemia; Induction Chemotherapy; Molecular Mutations; Prognosis, Survival.
  

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DOI: DOI: http://dx.doi.org/10.21088/ijcer.2321.9815.6218.2

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