Impact of pretreatment characteristics and salvage strategy on outcome in patients with relapsed acute myeloid leukemia

Despite intensive induction and consolidation therapy in newly diagnosed patients with acute myeloid leukemia (AML), approximately half of the younger patients and about 80−90% of the older patients relapse 1 , 2 , 3 and the majority of patients will succumb to their disease. The prognostic impact of clinical characteristics and genetic abnormalities, which are mostly assessed at initial diagnosis, is less clear. Currently, there is no commonly accepted standard for salvage treatment. 4 Allogeneic hematopoietic cell transplantation (HCT) offers the highest chance of cure in this clinical circumstance. 2 , 3 , 4 A study in 667 relapsed younger adults (15−60 years) of the HOVON study group revealed a longer relapse-free interval after first complete remission (CR1), presence of a core binding factor (CBF) AML at diagnosis, lower age at relapse and no previous stem-cell transplantation during first-line therapy as factors associated with more favorable prognosis. 5 More recently, additional favorable genetic markers have been reported, such as biallelic CEBPA mutations 6 and the genotype mutated NPM1 in the absence of FLT3 -ITD. 7