Multivariate analysis of prognostic factors in patients with refractory and relapsed acute myeloid leukemia undergoing sequential high-dose cytosine arabinoside and mitoxantrone (S-HAM) salvage therapy: relevance of cytogenetic abnormalities

To improve the basis for the stratification of patients with refractory and relapsed acute myeloid leukemia (AML) univariate and multivariate analyses of prognostic factors were performed in 254 patients (median age 50 years, range 18-74) undergoing S-HAM salvage chemotherapy during two consecutive prospective trials of the German AML Cooperative Group. In a multivariate a nalysis, duration of the first complete remission (CR) was the only factor associated with time to treatment failure (P = 0.0223). Disease-free surviv al was influenced by a short duration of the first CR of less than 6 months (P = 0.0001), WBC (P = 0.0018), blast count (P = 0.0037), and neutrophil c ount (P = 0.0119). The achievement of CR was related to the hemoglobin leve l only (P = 0.0457), the early death rate was related to age only (P = 0.01 09), and survival was related to the bilirubin level only (P = 0.0166). In the subgroup of 104 patients in whom additional karyotype analyses were per formed prior to first-line therapy unfavorable chromosome abnormalities wer e associated with a lower CR rate (univariate analysis, P = 0.0342; CR 24% vs 53%) and were the only factor related to survival. These analyses warran t the further evaluation of the impact of cytogenetic abnormalities on the outcome of patients with advanced AML in order to improve the characterizat ion according to duration of first CR and to WBC of distinct subgroups of p atients with differing prognoses as a basis for stratification in future tr ials.