Date of Award

January 2012

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Peter W. Marks

Second Advisor

Nikolai A. Podoltsev

Subject Area(s)

Medicine

Abstract

Acute myeloid leukemia (AML) is the most common acute leukemia affecting adults. Disease relapse represents the major cause of treatment failure in AML. Despite advancements in our understanding of the disease, outcomes associated with standard intensive chemotherapy for relapsed AML remain disappointing, and significant toxicities may further impact survival and quality of life. In an effort to identify the survival gain, the aim of this study was to compare intensive salvage chemotherapy and low intensity treatments in patients with relapsed or refractory AML in terms of complete response rate and overall survival. We reviewed the electronic medical records of seventy-three adults who received treatment for AML in first relapse or primary refractory disease at Yale-New Haven Hospital between January 1, 2000 and December 31, 2010 and collected relevant information. Results demonstrated a significantly higher complete response rate of 64.8% (n=35/54) in those who received intensive salvage chemotherapy compared to a complete response rate of 15.8% (n=3/19) with low intensity regimens (p<0.0001). Patients who received low intensity regimens were significantly older (62.3 years) than those treated with standard reinduction chemotherapy (53.4 years). Finally, median overall survival was 7.4 months for patients who received intensive salvage chemotherapy and 3.0 months in the low intensity treatment group (p=0.002). These results reveal that despite a marginal improvement in overall survival with intensive salvage chemotherapy, the outcome of relapsed and primary refractory AML is almost uniformly poor. This may serve as concrete information to facilitate discussion with patients about benefits and limitations of intensive treatment, including survival gain, and to aid in decision-making.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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