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Second- and Third-Line Salvage Chemotherapy Followed by Allogeneic Stem Cell Transplantation Leads to High Survival Rates in Primary Refractory AML—A Population-Based Study

Liew-Littorin, Markus ; Deleskog-Spångberg, Linn ; Deneberg, Stefan ; Janosi, Judit ; Lazarevic, Vladimir LU orcid ; Nilsson, Gustav ; Papageorgiou, Aristea ; Robelius, Anna ; Vennström, Lovisa and Juliusson, Gunnar LU , et al. (2025) In European Journal of Haematology
Abstract

Refractory acute myeloblastic leukemia (AML) is poorly studied. In this study, we characterized primary refractory AML and investigated treatment and outcome in a population-based setting. Based on all AML patients receiving intensive induction therapy at 12 Swedish hospitals from 2011 to 2018 (N = 1221), we identified 306 patients that failed to achieve composite complete remission (CRc) after first-line therapy. Two-hundred-sixteen (71%) of these patients received salvage treatment with intensive chemotherapy (ICT), of which 126 (58%) achieved CRc and 85 (39%) underwent allogeneic stem cell transplantation (HSCT). One- and 3-year overall survival (OS) in patients receiving salvage ICT were 56.8% and 28.9%, respectively. Secondary AML... (More)

Refractory acute myeloblastic leukemia (AML) is poorly studied. In this study, we characterized primary refractory AML and investigated treatment and outcome in a population-based setting. Based on all AML patients receiving intensive induction therapy at 12 Swedish hospitals from 2011 to 2018 (N = 1221), we identified 306 patients that failed to achieve composite complete remission (CRc) after first-line therapy. Two-hundred-sixteen (71%) of these patients received salvage treatment with intensive chemotherapy (ICT), of which 126 (58%) achieved CRc and 85 (39%) underwent allogeneic stem cell transplantation (HSCT). One- and 3-year overall survival (OS) in patients receiving salvage ICT were 56.8% and 28.9%, respectively. Secondary AML and adverse ELN risk were associated with worse OS after salvage ICT, while fludarabine-based FAIDA versus amsacrine-based ACE salvage and HSCT were associated with better OS. Three-year OS after first or second salvage chemotherapy, followed by HSCT were 55% and 71%, respectively. Refractory patients responding to salvage ICT showed only a nonsignificant trend toward inferior OS compared to patients in CRc after the first cycle. In conclusion, refractory AML patients eligible for further intensive therapy have a reasonable chance of obtaining remission and long-term survival when followed by HSCT. The results can serve as a basis for evaluation of new treatments in refractory AML.

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publishing date
type
Contribution to journal
publication status
epub
subject
keywords
acute, leukemia, myeloid, refractory, retrospective study
in
European Journal of Haematology
publisher
Wiley-Blackwell
external identifiers
  • scopus:105011827733
  • pmid:40703057
ISSN
0902-4441
DOI
10.1111/ejh.70009
language
English
LU publication?
no
additional info
Publisher Copyright: © 2025 The Author(s). European Journal of Haematology published by John Wiley & Sons Ltd.
id
b42dc2db-5e01-43ea-a5f3-5b58e32540bc
date added to LUP
2025-08-06 19:44:15
date last changed
2025-09-03 22:11:37
@article{b42dc2db-5e01-43ea-a5f3-5b58e32540bc,
  abstract     = {{<p>Refractory acute myeloblastic leukemia (AML) is poorly studied. In this study, we characterized primary refractory AML and investigated treatment and outcome in a population-based setting. Based on all AML patients receiving intensive induction therapy at 12 Swedish hospitals from 2011 to 2018 (N = 1221), we identified 306 patients that failed to achieve composite complete remission (CRc) after first-line therapy. Two-hundred-sixteen (71%) of these patients received salvage treatment with intensive chemotherapy (ICT), of which 126 (58%) achieved CRc and 85 (39%) underwent allogeneic stem cell transplantation (HSCT). One- and 3-year overall survival (OS) in patients receiving salvage ICT were 56.8% and 28.9%, respectively. Secondary AML and adverse ELN risk were associated with worse OS after salvage ICT, while fludarabine-based FAIDA versus amsacrine-based ACE salvage and HSCT were associated with better OS. Three-year OS after first or second salvage chemotherapy, followed by HSCT were 55% and 71%, respectively. Refractory patients responding to salvage ICT showed only a nonsignificant trend toward inferior OS compared to patients in CRc after the first cycle. In conclusion, refractory AML patients eligible for further intensive therapy have a reasonable chance of obtaining remission and long-term survival when followed by HSCT. The results can serve as a basis for evaluation of new treatments in refractory AML.</p>}},
  author       = {{Liew-Littorin, Markus and Deleskog-Spångberg, Linn and Deneberg, Stefan and Janosi, Judit and Lazarevic, Vladimir and Nilsson, Gustav and Papageorgiou, Aristea and Robelius, Anna and Vennström, Lovisa and Juliusson, Gunnar and Uggla, Bertil and Höglund, Martin and Lehmann, Sören}},
  issn         = {{0902-4441}},
  keywords     = {{acute; leukemia; myeloid; refractory; retrospective study}},
  language     = {{eng}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{European Journal of Haematology}},
  title        = {{Second- and Third-Line Salvage Chemotherapy Followed by Allogeneic Stem Cell Transplantation Leads to High Survival Rates in Primary Refractory AML—A Population-Based Study}},
  url          = {{http://dx.doi.org/10.1111/ejh.70009}},
  doi          = {{10.1111/ejh.70009}},
  year         = {{2025}},
}