Urgent Cytoreduction for Newly Diagnosed Acute Myeloid Leukemia Patients Allows Acquisition of Pretreatment Genomic Data and Enrollment on Investigational Clinical Trials

Authors

Kunhwa Kim
Marina Konopleva
Courtney D DiNardo
Gautam Borthakur
Sanam Loghavi
Guilin Tang
Naval Daver
Naveen Pemmaraju
Elias Jabbour
Caitlin R Rausch
Musa Yilmaz
Koji Sasaki
Nicholas J Short
Nitin Jain
Mark Brandt
Sherry Pierce
Guillermo Garcia-Manero
Farhad Ravandi
Hagop Kantarjian
Tapan M Kadia

Publication Date

7-1-2022

Journal

American Journal of Hematology

Abstract

Newly diagnosed acute myeloid leukemia is often deemed a medical emergency, requiring urgent treatment. This is in contradiction with the need for accurate cytogenetic and molecular data, which is not immediately available, to select optimal therapy. We hypothesized that cytoreduction with hydroxyurea or cytarabine would enable urgent disease control and provide a bridge to clinical trial enrollment. We analyzed three prospective frontline clinical trials that allowed the use of cytoreduction before treatment initiation. Among 274 patients with a median age of 62 (range, 18-89), there was no significant difference in short- and long-term outcome and safety among patients who did (CytoRed) or did not receive (NoCytoRed) cytoreduction. The overall response rate in CytoRed group was 91%, compared with 86% in NoCytoRed group (p = .264). The 30- and 60-day mortality rates were 2% and 7% in CytoRed group, compared with 2% (p = .978) and 6% (p = .652) in NoCytoRed group, respectively. There was no significant difference in overall survival (OS) between in CytoRed group compared with NoCytoRed group (Hazard ratio 0.97, 95% CI 0.70-1.37, p = .879). Results were unchanged after stratification by age (< or ≥65 years) or after multivariate analyses for OS. Our data suggests that urgent cytoreduction using hydroxyurea or cytarabine is a feasible and safe approach to facilitate acquisition of complete diagnostic information prior to treatment initiation on a clinical trial.

Keywords

Adolescent, Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols, Clinical Trials as Topic, Cytarabine, Cytoreduction Surgical Procedures, Genomics, Humans, Hydroxyurea, Leukemia, Myeloid, Acute, Middle Aged, Prospective Studies, Treatment Outcome, Young Adult

DOI

10.1002/ajh.26572

PMID

35413152

PMCID

PMC12002036

PubMedCentral® Posted Date

4-16-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes