Authors: Dario Ferrero Elena Crisà Filippo Marmont Ernesta Audisio Chiara Frairia Valentina Giai Tiziana Gatti Moreno Festuccia Benedetto Bruno Ludovica Riera Roberto Passera Mario Boccadoro
Publish Date: 2014/04/06
Volume: 93, Issue: 8, Pages: 1391-1400
Abstract
We evaluated a maintenance postremission treatment with lowdose chemotherapy plus differentiating agents on poorprognosis acute myeloid leukemia AML/myelodysplastic syndrome MDS patients ineligible to allografting Patients had either age over 60 and/or secondary AML therapyrelated AML previous relapse highrisk MDS Fortyfive patients received the maintenance therapy based on two alternated schedules a 6thioguanine + 13cis retinoic acid + dihydroxylated vitamin D3 and b lowdose cytarabine + 6mercaptopurine + alltrans retinoic acid + dihydroxylated vitamin D3 We compared their outcome at a median followup of 52 months to that of a matched population of 49 patients who stopped treatments after consolidation Maintenance group had a lower relapse incidence 703 vs 864 at 5 years p = 0007 and a longer diseasefree survival median 212 vs 87 months p = 0017 The relapse reduction improved overall survival median 404 months 359 at 5 years for maintenance group vs 158 142 at 5 years for controls p = 0005 At multivariate Cox analysis both cytogenetic and maintenance therapies resulted independent outcome predictors for overall survival Maintenance treatment also reduced minimal residual disease detected by WT1 and CBFβMYH11 in five of eight evaluable patients The present results suggest that our strategy of maintenance therapy might improve the outcome of poorrisk AML/MDS patientsDF designed the study treated patients and wrote the paper EC collected and analyzed datatreated patients and wrote the paper FM EA CF VG BB treated patients and reviewed the paper TG e MF collected data TG also helped in manuscript preparation RP performed statistical analysis LR performed molecular analysis MB and BB supervised the research and provided funds
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