Defining the Optimal Total Number of Chemotherapy Courses in Younger Patients With Acute Myeloid Leukemia: A Comparison of Three Versus Four Courses

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Defining the Optimal Total Number of Chemotherapy Courses in Younger Patients With Acute Myeloid Leukemia : A Comparison of Three Versus Four Courses. / Burnett, Alan K; Russell, Nigel H; Hills, Robert K; Knapper, Stephen; Freeman, Sylvie; Huntly, Brian; Clark, Richard E; Thomas, Ian F; Kjeldsen, Lars; McMullin, Mary Frances; Drummond, Mark; Kell, Jonathan; Spearing, Ruth.

In: Journal of Clinical Oncology , 23.12.2020, p. JCO2001170.

Research output: Contribution to journalArticlepeer-review

Harvard

Burnett, AK, Russell, NH, Hills, RK, Knapper, S, Freeman, S, Huntly, B, Clark, RE, Thomas, IF, Kjeldsen, L, McMullin, MF, Drummond, M, Kell, J & Spearing, R 2020, 'Defining the Optimal Total Number of Chemotherapy Courses in Younger Patients With Acute Myeloid Leukemia: A Comparison of Three Versus Four Courses', Journal of Clinical Oncology , pp. JCO2001170. https://doi.org/10.1200/JCO.20.01170

APA

Burnett, A. K., Russell, N. H., Hills, R. K., Knapper, S., Freeman, S., Huntly, B., Clark, R. E., Thomas, I. F., Kjeldsen, L., McMullin, M. F., Drummond, M., Kell, J., & Spearing, R. (2020). Defining the Optimal Total Number of Chemotherapy Courses in Younger Patients With Acute Myeloid Leukemia: A Comparison of Three Versus Four Courses. Journal of Clinical Oncology , JCO2001170. https://doi.org/10.1200/JCO.20.01170

Vancouver

Author

Burnett, Alan K ; Russell, Nigel H ; Hills, Robert K ; Knapper, Stephen ; Freeman, Sylvie ; Huntly, Brian ; Clark, Richard E ; Thomas, Ian F ; Kjeldsen, Lars ; McMullin, Mary Frances ; Drummond, Mark ; Kell, Jonathan ; Spearing, Ruth. / Defining the Optimal Total Number of Chemotherapy Courses in Younger Patients With Acute Myeloid Leukemia : A Comparison of Three Versus Four Courses. In: Journal of Clinical Oncology . 2020 ; pp. JCO2001170.

Bibtex

@article{0efded9f28fc40fbb31d200e2fc61418,
title = "Defining the Optimal Total Number of Chemotherapy Courses in Younger Patients With Acute Myeloid Leukemia: A Comparison of Three Versus Four Courses",
abstract = "PURPOSE: The optimum number of treatment courses for younger patients with acute myeloid leukemia (AML) is uncertain. The United Kingdom National Cancer Research Institute AML17 trial randomly assigned patients who were not high risk to a total of three versus four courses.PATIENTS AND METHODS: Patients received two induction courses based on daunorubicin and cytarabine (Ara-C), usually with gemtuzumab ozogamicin. Following remission, 1,017 patients were randomly assigned to a third course, MACE (amsacrine, etoposide, and Ara-C), plus a fourth course of MidAc (mitoxantrone and Ara-C) and following an amendment to one or two courses of high-dose Ara-C. Primary end points were cumulative incidence of relapse (CIR), relapse-free survival (RFS), and overall survival (OS). Outcomes were correlated with patient characteristics, mutations, cytogenetics, induction treatments, and measurable residual disease (MRD) postinduction.RESULTS: In logrank analyses, CIR and RFS at 5 years were improved in recipients of four courses (50% v 58%: hazard ratio [HR] 0.81 [0.69-0.97], P = .02 and 43% v 36%: HR 0.83 [0.71-0.98], P = .03, respectively). While OS was not significantly better (63% v 57%: HR 0.84 [0.69-1.03], P = .09), the noninferiority of three courses to four courses was not established. The impact on relapse was only significant when the fourth course was Ara-C. In exploratory analyses, although MRD impacted survival, a fourth course had no effect in either MRD-positive or MRD-negative patients. A fourth course was beneficial in patients who lacked a mutation of FLT3 or NPM1, had < 3 mutations in other genes, or had a presenting WBC of < 10 × 109 L-1.CONCLUSION: Although a fourth course of high-dose Ara-C reduced CIR and improved RFS, it did not result in a significant OS benefit. Subsets including those with favorable cytogenetics, those lacking a mutation of FLT3 or NPM1, or those with < 3 other mutations may derive survival benefit.",
author = "Burnett, {Alan K} and Russell, {Nigel H} and Hills, {Robert K} and Stephen Knapper and Sylvie Freeman and Brian Huntly and Clark, {Richard E} and Thomas, {Ian F} and Lars Kjeldsen and McMullin, {Mary Frances} and Mark Drummond and Jonathan Kell and Ruth Spearing",
year = "2020",
month = dec,
day = "23",
doi = "10.1200/JCO.20.01170",
language = "English",
pages = "JCO2001170",
journal = "Journal of Clinical Oncology ",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",

}

RIS

TY - JOUR

T1 - Defining the Optimal Total Number of Chemotherapy Courses in Younger Patients With Acute Myeloid Leukemia

T2 - A Comparison of Three Versus Four Courses

AU - Burnett, Alan K

AU - Russell, Nigel H

AU - Hills, Robert K

AU - Knapper, Stephen

AU - Freeman, Sylvie

AU - Huntly, Brian

AU - Clark, Richard E

AU - Thomas, Ian F

AU - Kjeldsen, Lars

AU - McMullin, Mary Frances

AU - Drummond, Mark

AU - Kell, Jonathan

AU - Spearing, Ruth

PY - 2020/12/23

Y1 - 2020/12/23

N2 - PURPOSE: The optimum number of treatment courses for younger patients with acute myeloid leukemia (AML) is uncertain. The United Kingdom National Cancer Research Institute AML17 trial randomly assigned patients who were not high risk to a total of three versus four courses.PATIENTS AND METHODS: Patients received two induction courses based on daunorubicin and cytarabine (Ara-C), usually with gemtuzumab ozogamicin. Following remission, 1,017 patients were randomly assigned to a third course, MACE (amsacrine, etoposide, and Ara-C), plus a fourth course of MidAc (mitoxantrone and Ara-C) and following an amendment to one or two courses of high-dose Ara-C. Primary end points were cumulative incidence of relapse (CIR), relapse-free survival (RFS), and overall survival (OS). Outcomes were correlated with patient characteristics, mutations, cytogenetics, induction treatments, and measurable residual disease (MRD) postinduction.RESULTS: In logrank analyses, CIR and RFS at 5 years were improved in recipients of four courses (50% v 58%: hazard ratio [HR] 0.81 [0.69-0.97], P = .02 and 43% v 36%: HR 0.83 [0.71-0.98], P = .03, respectively). While OS was not significantly better (63% v 57%: HR 0.84 [0.69-1.03], P = .09), the noninferiority of three courses to four courses was not established. The impact on relapse was only significant when the fourth course was Ara-C. In exploratory analyses, although MRD impacted survival, a fourth course had no effect in either MRD-positive or MRD-negative patients. A fourth course was beneficial in patients who lacked a mutation of FLT3 or NPM1, had < 3 mutations in other genes, or had a presenting WBC of < 10 × 109 L-1.CONCLUSION: Although a fourth course of high-dose Ara-C reduced CIR and improved RFS, it did not result in a significant OS benefit. Subsets including those with favorable cytogenetics, those lacking a mutation of FLT3 or NPM1, or those with < 3 other mutations may derive survival benefit.

AB - PURPOSE: The optimum number of treatment courses for younger patients with acute myeloid leukemia (AML) is uncertain. The United Kingdom National Cancer Research Institute AML17 trial randomly assigned patients who were not high risk to a total of three versus four courses.PATIENTS AND METHODS: Patients received two induction courses based on daunorubicin and cytarabine (Ara-C), usually with gemtuzumab ozogamicin. Following remission, 1,017 patients were randomly assigned to a third course, MACE (amsacrine, etoposide, and Ara-C), plus a fourth course of MidAc (mitoxantrone and Ara-C) and following an amendment to one or two courses of high-dose Ara-C. Primary end points were cumulative incidence of relapse (CIR), relapse-free survival (RFS), and overall survival (OS). Outcomes were correlated with patient characteristics, mutations, cytogenetics, induction treatments, and measurable residual disease (MRD) postinduction.RESULTS: In logrank analyses, CIR and RFS at 5 years were improved in recipients of four courses (50% v 58%: hazard ratio [HR] 0.81 [0.69-0.97], P = .02 and 43% v 36%: HR 0.83 [0.71-0.98], P = .03, respectively). While OS was not significantly better (63% v 57%: HR 0.84 [0.69-1.03], P = .09), the noninferiority of three courses to four courses was not established. The impact on relapse was only significant when the fourth course was Ara-C. In exploratory analyses, although MRD impacted survival, a fourth course had no effect in either MRD-positive or MRD-negative patients. A fourth course was beneficial in patients who lacked a mutation of FLT3 or NPM1, had < 3 mutations in other genes, or had a presenting WBC of < 10 × 109 L-1.CONCLUSION: Although a fourth course of high-dose Ara-C reduced CIR and improved RFS, it did not result in a significant OS benefit. Subsets including those with favorable cytogenetics, those lacking a mutation of FLT3 or NPM1, or those with < 3 other mutations may derive survival benefit.

U2 - 10.1200/JCO.20.01170

DO - 10.1200/JCO.20.01170

M3 - Article

C2 - 33356418

SP - JCO2001170

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

ER -