P-OT020. Profile and mortality rate of cerebrovascular accident in patient with acute myeloid leukemia in dr. Sardjito hospital yogyakarta

The Eastern Cooperative Oncology Group (ECOG) conducted a randomized trial in patients less than or equal to 65 years old (median, 44 years) to determine whether increasing the intensity of postremission therapy in acute myeloid leukemia (AML) would improve the outcome. After uniform induction therapy, patients in complete remission (CR) who were less than 41 years old and who had a histocompatible sibling underwent allogeneic bone marrow transplantation (alloBMT) (54 patients). The remainder of patients in CR were randomized to receive either 2 years of continuous outpatient maintenance therapy with cytarabine and 6- thioguanine (83 patients) or a single course of inpatient consolidation therapy consisting of 6 days of high-dose cytarabine plus 3 days of amsacrine (87 patients). The median duration of follow-up is now 4 years, and patients are included in the analyses of outcome regardless of whether they relapsed before starting the intended treatment. Four- year event-free survival (EFS) was 27% +/- 10% for consolidation therapy versus 16% +/- 8% for maintenance therapy (P = .068) and 28% +/- 11% versus 15% +/- 9% (P = .047) in patients less than 60 years old. The outcome for patients receiving alloBMT was compared with the subset of patients less than 41 years old who received consolidation therapy (N = 29) or maintenance therapy (N = 21). Four-year EFS was 42% +/- 13% for alloBMT, 30% +/- 17% for consolidation therapy, and 14% +/- 15% for maintenance therapy. AlloBMT had a significantly better EFS (P = .013) than maintenance therapy, but was not different from consolidation therapy. In patients less than 41 years old, 4-year survival after alloBMT (42% +/- 14%) did not differ from consolidation therapy (43% +/- 18%), but both were significantly better than maintenance therapy (19% +/- 17%), P = .047 and .043, respectively. The mortality rate for maintenance therapy was 0%, consolidation therapy, 21%; and alloBMT, 36%. Consolidation therapy caused an especially high mortality rate in the patients greater than or equal to 60 years old (8 of 14 or 57%). The toxicity of combined high-dose cytarabine and amsacrine is unacceptable, especially in older patients, and alternative approaches to consolidation therapy such as high-dose cytarabine alone need to be tested. In AML, a single course of consolidation therapy or alloBMT after initial CR produces better results than lengthy maintenance therapy. Although EFS and survival of alloBMT and consolidation therapy do not differ significantly, a larger number of patients need to be studied before concluding that they are equivalent.

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Early mortality rate (EMR) and complications in adults with acute myeloid leukemia (AML) in California.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.15_suppl.e13091 ◽

2016 ◽

Vol 34 (15_suppl) ◽

pp. e13091-e13091

Author(s):

Gwendolyn Ho ◽

Brian Andrew Jonas ◽

Qian Li ◽

Ann Brunson ◽

Theodore Wun ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Mortality Rate ◽

Myeloid Leukemia ◽

Early Mortality ◽

Acute Myeloid

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Redefining Remission Induction Chemotherapy Ineligibility by Early Mortality in De Novo Acute Myeloid Leukemia

Journal of Clinical Medicine ◽

10.3390/jcm10245768 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5768

Author(s):

You-Cheng Li ◽

Yu-Hsuan Shih ◽

Tsung-Chih Chen ◽

Jyh-Pyng Gau ◽

Yu-Chen Su ◽

...

Keyword(s):

Risk Factors ◽

Acute Myeloid Leukemia ◽

Mortality Rate ◽

Induction Chemotherapy ◽

Myeloid Leukemia ◽

Group Performance ◽

De Novo ◽

Early Mortality ◽

Remission Induction ◽

Acute Myeloid

The therapeutic strategies for acute myeloid leukemia (AML) patients ineligible for remission induction chemotherapy have been improving in the past decade. Therefore, it is important to define ineligibility for remission induction chemotherapy. We retrospectively assessed 153 consecutive adult de novo AML patients undergoing remission induction chemotherapy and defined early mortality as death within the first 60 days of treatment. The 153 patients were stratified into the early mortality group (n = 29) and the non-early mortality group (n = 124). We identified potential factors to which early mortality could be attributed, investigated the cumulative incidence of early mortality for each aspect, and quantified the elements. The early mortality rate in our study cohort was 19.0%. Age ≥ 65 years (odds ratio (OR): 3.15; 95% confidence interval (CI): 1.05–9.44; p = 0.041), Eastern Cooperative Oncology Group performance status ≥ 2 (OR: 4.87; 95% CI: 1.77–13.41; p = 0.002), and lactate dehydrogenase ≥ 1000 IU/L (OR: 4.20; 95% CI: 1.57–11.23; p = 0.004) were the risk factors that substantially increased early mortality in AML patients. Patients with two risk factors had a significantly higher early mortality rate than those with one risk factor (68.8% vs. 20.0%; p < 0.001) or no risk factors (68.8% vs. 9.2%; p < 0.001). In conclusion, older age, poor clinical performance, and a high tumor burden were risks for early mortality in AML patients receiving remission induction chemotherapy. Patients harboring at least two of these three factors should be more carefully assessed for remission induction chemotherapy.

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Assessing Efficacy and Safety of Daunorubicin and Cytarabine Liposomal in Patients with Acute Myeloid Leukemia

Blood ◽

10.1182/blood-2019-131328 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5134-5134

Author(s):

Elizabeth Rogers ◽

Maho Hibino ◽

Rebecca Garcia Hunt ◽

Leslie Renee Ellis ◽

Rupali Bhave ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Mortality Rate ◽

Complete Remission ◽

Myeloid Leukemia ◽

Research Funding ◽

Comprehensive Cancer Center ◽

Report Generation ◽

Free Survival ◽

Younger Patients ◽

Acute Myeloid

Background. Acute myeloid leukemia (AML) is the most common acute leukemia in adults. The median age of diagnosis is 67 years old, and it has unfavorable outcomes in older patients. Approximately one-third of patients are diagnosed after the age of 75. Thus, as the population continues to increase in age, the incidence of AML will continue to expand (NCCN guidelines: AML. Version 3.2019). The long term disease free survival (DFS) rates for patients > 60 years of age is 5-15% whereas younger patients < 60 years of age have a better DFS rate of up to 40% (Dohner H, et al. N Engl J Med. 2015). Recent advancements have been made in patients with AML, including the approval of daunorubicin and cytarabine liposomal (Vyxeos®) for the treatment of adults with 2 poor risk types of AML: newly diagnosed therapy related AML (t-AML) or AML with myelodysplasia-related changes (AML-MRC). Given the financial constraints of this new medication, our objective was to determine the safety and efficacy of daunorubicin and cytarabine liposomal in our adult patients with t-AML and AML-MRC at a single academic medical center. Methods. This was a single center, retrospective, chart review at Wake Forest Baptist Health (WFBH) Comprehensive Cancer Center from August 1, 2017 to November 1, 2018. Patients were selected via report generation if they had received at least one dose of daunorubicin and cytarabine liposomal during the study period. The initial induction dose of daunorubicin and cytarabine liposomal was 44 mg/m2 of daunorubicin and 100 mg/m2 cytarabine administered on days 1, 3, and 5 for up to 2 cycles to achieve remission. If a second induction was necessary, the same induction doses were given on days 1 and 3 only. The consolidation dose was 29 mg/m2 of daunorubicin and 65 mg/m2 of cytarabine on days 1 and 3 for up to 2 cycles. The primary endpoint was overall survival (OS). Secondary endpoints included event free survival (EFS), 30-day and 60-day mortality, complete remission (CR) and morphologic complete remission with incomplete blood count recovery (CRi), adverse drug reactions, and financial impact to the health system. Descriptive statistics were utilized for demographic data. Time to event data was analyzed using the Kaplan-Meier method. SPSS IBM and Microsoft Excel Software were utilized for data analysis. Results. A total of 37 AML patients were identified as receiving daunorubicin and cytarabine liposomal from August 2017 to November 2018. Of those 37 patients, 27 had AML-MRC and 10 had t-AML. The average patient was a 70 year old Caucasian male with an ECOG performance status of 1 and a Charlson Comorbidity Index of 6 (Table 1). The median OS was 10 months and EFS was 7 months. The 30-day mortality rate was 16% and 60-day mortality rate was 19%. Eighteen patients (49%) achieved a CR and 2 patients (5%) achieved a CRi. A subgroup analysis was conducted for prior hypomethylating agent (HMA) use, age > 75 years old, < 60 years old, molecular mutations including FLT3-ITD and TP53 mutations, and t-AML. Poorer outcomes were noted in patients > age 75, prior HMA use, and the t-AML subgroups. Table 3 highlights the OS, 60-day mortality rate, transplant received and CR+CRi for each subgroup. The median time to platelet and absolute neutrophil count (ANC) recovery was 32 and 33 days, respectively. Eight patients (21.6%) proceeded to transplant post administration of daunorubicin and cytarabine liposomal. All patients experienced at least one adverse event with hematologic being the most commonly observed toxicity (Table 4). Most patients received induction therapy with daunorubicin and cytarabine liposomal in the inpatient setting whereas consolidation was predominantly administered in an outpatient encounter. Conclusions. Daunorubicin and cytarabine liposomal was considered an effective treatment option for patients with t-AML and AML-MRC with a CR+CRi rate of 54%. Younger patients (< 60 years old) exhibited the greatest benefit with an OS of 12 months and 60 day mortality rate of 0%. However, poorer outcomes were demonstrated in elderly patients (> 75 years old), patients with FLT3-ITD positive mutations, and patients with previous HMA use, with an OS less than 2 months in each subgroup and mortality rates ranging up to 60%. Thus, additional studies are necessary to determine the role of daunorubicin and cytarabine liposomal in these higher risk patient subgroups > age 75, FLT3-ITD positive patients, and patients with previous HMA use. Disclosures Manuel: Novartis: Speakers Bureau; Jazz Pharmaceuticals: Speakers Bureau. Pardee:Rafael Pharmaceuticals: Consultancy, Research Funding; Karyopharm: Research Funding; Spherix Intellectual Property: Research Funding; Pharmacyclics/Janssen: Speakers Bureau; Celgene: Speakers Bureau; Amgen: Speakers Bureau; CBM Bipharma: Membership on an entity's Board of Directors or advisory committees. Powell:Janssen: Research Funding; Rafael Pharmaceuticals: Consultancy, Research Funding; Novartis: Consultancy, Speakers Bureau; Jazz Pharmaceuticals: Consultancy, Research Funding, Speakers Bureau; Pfizer: Consultancy, Research Funding.

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Thoracoscopic Lingulectomy for Invasive Pulmonary Aspergillosis

The American Surgeon ◽

10.1177/000313480707300317 ◽

2007 ◽

Vol 73 (3) ◽

pp. 279-280 ◽

Cited By ~ 1

Author(s):

Bryan A. Whitson ◽

Michael A. Maddaus ◽

Rafael S. Andrade

Keyword(s):

Acute Myeloid Leukemia ◽

Mortality Rate ◽

Myeloid Leukemia ◽

Immunocompromised Patient ◽

Lung Resection ◽

Invasive Pulmonary Aspergillosis ◽

Immunocompromised Patients ◽

Anatomic Resection ◽

Pulmonary Aspergillosis ◽

Acute Myeloid

Invasive pulmonary aspergillosis (IPA) is associated with a high mortality rate in immunocompromised patients. Surgery has a therapeutic role for selected patients when the main objective is to achieve infection control with minimal lung resection. Large or deep-seated lesions may require an anatomic resection such as segmentectomy, lobectomy, or pneumonectomy. Thoracoscopic lobectomy has been described as a treatment of localized IPA; however, thoracoscopic anatomic segmentectomy has not been reported until now. Herein, we describe a case of thoracoscopic lingulectomy for localized IPA in an immunocompromised patient: this operation minimized the delay in resuming therapy for the patient's underlying acute myeloid leukemia. Video-assisted thoracoscopic segmentectomy can be safely performed for localized IPA.

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Cancrum Oris-associated with Acute Myeloid Leukemia: A Forgotten Disease

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1032 ◽

2010 ◽

Vol 1 (3) ◽

pp. 167-169

Author(s):

Arvind Krishnamurthy ◽

Shirley Sundersingh ◽

Satish Srinivas ◽

Anita Vaidhyanathan ◽

Krishnarathinam LNU

Keyword(s):

Acute Myeloid Leukemia ◽

Mortality Rate ◽

Oral Hygiene ◽

Myeloid Leukemia ◽

Bacterial Infections ◽

Poor Oral Hygiene ◽

Faecal Contamination ◽

Cancrum Oris ◽

The Face ◽

Acute Myeloid

Abstract Cancrum oris is an orofacial gangrene, which during its fulminating course causes, progressive and mutilating destruction of the infected tissues with a consortium of microorganisms. This condition is considered to represent the “face of poverty” because factors connected with poverty, such as chronic malnutrition, poor oral hygiene and sanitation, faecal contamination, and exposure to viral and bacterial infections in an immunosupressed host contribute to disease progression. This condition is seen almost exclusively among the young children and carries a high mortality rate. We present a case of cancrum oris in a 45 years old lady being treated for acute myeloid leukemia with chemotherapy, who in addition to a polymicrobial bacterial infection had superinfection with Mucormycosis.

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Treating Acute Myeloid Leukemia in Patients Presenting with COVID-19

Clinical Oncology and Research ◽

10.31487/j.cor.2020.07.05 ◽

2020 ◽

pp. 1-3

Author(s):

Ine Moors ◽

Rutger Callens ◽

Dieter Stevens ◽

Sebastiaan Dhont ◽

Elise Peys ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Mortality Rate ◽

Myeloid Leukemia ◽

Hematological Malignancies ◽

Outpatient Basis ◽

Lower Intensity ◽

Institutional Approach ◽

Increased Risk ◽

The Face ◽

Acute Myeloid

Patients with hematological malignancies are at increased risk for severe COVID-19 with a high mortality rate. In AML, more and more patients are treated on an outpatient basis. This gives rise to two dilemmas in the face of COVID-19. The first one is whether to temporarily interrupt the oral antileukemia treatment and the second one is which patients should be intubated. Here, we describe our institutional approach and the underlying rationale in patients on lower intensity treatments for AML presenting with COVID-19

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Etiologies and Predictors of 30-Day Readmission in Patients Undergoing Induction Chemotherapy for Acute Myeloid Leukemia

Blood ◽

10.1182/blood-2019-132180 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4759-4759

Author(s):

Shivani Handa ◽

Kamesh Gupta ◽

Jasdeep Singh Sidhu ◽

Giulia Petrone ◽

Sridevi Rajeeve ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Mortality Rate ◽

Length Of Stay ◽

Induction Chemotherapy ◽

Low Income ◽

Myeloid Leukemia ◽

Readmission Rate ◽

Index Admission ◽

Hospitalization Costs ◽

Acute Myeloid

Introduction: Early readmissions are important indicators of quality of health-care. National-level data is currently lacking for patients admitted for induction chemotherapy for acute myeloid leukemia (AML). Our study is to investigate characteristics and predictors of 30-day hospital readmission in patients with AML after receiving induction chemotherapy. Methods: We analyzed the 2016 United States National Readmission Database, the latest and largest readmission database available so far. The authors identified hospitalizations for patients using ICD-10 codes for "encounter for chemotherapy" or a procedure code for administration of antineoplastic agent as the primary diagnosis with a secondary diagnosis of acute myeloid leukemia or myeloid sarcoma. We excluded patients who had a personal history of chemotherapy or those in remission or relapse in order to avoid counting patients admitted for consolidation/ re-induction chemotherapy. A readmission was defined as the first admission to any hospital for any non-traumatic diagnosis within 30 days of discharge after the index admission. Same day admissions and discharges were excluded. The primary outcome was 30-day readmission rate. Secondary outcomes were 30-day mortality rate, most common reasons for readmission, readmission mortality rate and resource utilization (length of stay and hospitalization costs). Independent risk factors for readmission were identified using multivariate regression analysis. Results: A total of 18,140 admissions were identified for induction chemotherapy. The median age was 64.1 years and 45% of patients were female. The all cause 30-day readmission rates were 30.1%. The in-hospital and 30-day mortality rate were 3.9% and 4.8%, respectively. The in-hospital mortality rate for readmitted patients was 3.8%. The top five causes for unplanned readmissions were neutropenia (7.2%), sepsis (6.1%), pneumonia (2.6%), acute kidney injury (2.5%) and neoplasm related pain (2.3%). Mean total charges were higher during index admission than readmission ($118,449 vs $49,087, p=.000). Table 1 shows the base patient characteristics and Table 2 shows the odds ratios of the various factors tested as independent predictors of readmission. Independent predictors of readmission were younger age, low income, Medicaid, uninsured or Private Insurance, co-morbidities, urban hospital and length of stay during index hospitalization. The total hospital days associated with readmission were 102,924 days, with a total healthcare economic burden of $303 million. Conclusions: Our study reveals that there is a significant readmission rate in this study population generating a substantial financial burden. 30-day readmissions are primarily due to neutropenia and infectious etiologies including sepsis and pneumonia. This emphasizes the urgent need for organizing better outpatient follow up for these patients post-hospitalization as well as increased awareness for antibiotic prophylaxis. Further research into development of clinical models for risk stratification is also required. Disclosures Rajeeve: ASH-HONORS Grant: Research Funding.

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An Integer Weighted Genomic Mutation Scoring (IWGMS) Using the Trusight Myeloid Sequencing Panel (Illumina) Shows Higher Mortality in Patients with Intermediate Risk Acute Myeloid Leukemia- a Retrospective Study

Blood ◽

10.1182/blood.v128.22.2889.2889 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2889-2889

Author(s):

Xinyu Nan ◽

Michael Greenwood ◽

Cesar Gentille Sanchez ◽

Yan Xing ◽

Arthur Zieske ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Transcription Factor ◽

Mortality Rate ◽

Myeloid Leukemia ◽

Research Funding ◽

Univariate Analysis ◽

Mutation Score ◽

Genomic Mutation ◽

Center Research ◽

Acute Myeloid

Abstract Background: Acute Myeloid Leukemia (AML) without favorable and particular unfavorable cytogenetic aberrations is classified as intermediate prognosis. Recurrent somatic genomic mutations through The Cancer Genome Atlas (TCGA) have provided valuable prognostic information in AML. There are very few studies that have incorporated the cytogenetics (Cy), Next Generation sequencing (NGS) and Overall Survival (OS) in AML. Moreover prognostic NGS studies have a limited collective context without a quantifiable stratification. For the purpose of prognostic risk stratification, we utilized the TCGA data by Ley et.al and developed a system of Integer Weights for the Genomic Mutation Score (IWGMS) obtained by targeted NGS at Houston Methodist Hospital. We then correlated the IWGMS with patients' outcomes in a retrospective manner. Methods: The patient data was queried from METEOR (Methodist Environment for Translational Enhancement and Outcomes Research), a clinical data warehouse that integrates existing data with internal and external research databases and national registries. We queried for the diagnosis of AML and demographics, Cy, NGS and OS. We divided the patients into 3 groups according to their MRC cytogenetic risks- Favorable (FCy), Intermediate (ICy), Poor (PCy)). Mutations in 54 genes associated with myeloid disorders were tested in NGS by using the TruSight Myeloid Sequencing Panel (Illumina) (Table 1). Briefly, genomic DNA was extracted from sorted specimens using automated methods on the MagnaPure Compact instrument (Roche Diagnostics). Sequencing libraries were prepared using TruSight reagents and sequenced on a MiSeq instrument using a 2x300 bp paired end strategy. Read alignment and variant calling for minimum of 100x amplicon coverage was performed using VariantStudio Software (Illumina). The biologic significance of detected variants was determined using VarView5 (an in-house developed bioinformatics tool). Interpretations are reviewed in a consensus conference. For the data described herein, interpretations were limited to known nonsynonymous (single nucleotide polymorphsims and insertions or deletions) somatic mutations. Results: Of the 1200 AML patients reviewed, 100 patients meet the criteria for having the information on Cy and NGS. The mortality rate for FCy, ICy and PCy groups are 43%, 52%, and 51% respectively. IWGMS was designed by assigning a score for each genomic mutation between the range of negative 2 (-2) for good risk to positive 2 (+2) for each of 9 TCGA mutation categories (Transcription- Factor Fusion, Nucleophosmin (NPM1), Tumor Suppressor Genes, DNA-Methylation related genes, Signaling Genes, Chromatin Modifying Genes, Myeloid Transcription Factor Genes, Cohesion complex Genes and Spliceosome-complex genes). The total IWGMS for each patient was calculated by the sum of mutation scores in each 9 categories. The score greater than 3 was defined as high risk. By univariate analysis, in the ICy, high IWGMS was associated with significantly higher mortality rate than low IWGMS (80% vs 44%, p=0.045). In PCy, patients with high IWGMS and low IWGMS had similar mortality rate (50% vs 52%, p=0.910) (Table 1). Conclusions: We have developed an IWGMS system to stratify patients with ICy into high and low risk groups. Our result demonstrated the significance of high mutation score in this group of patients, which will impact the management. The identification of genomic alterations along with the scoring system has a great potential for developing rationally-targeted therapies and improving outcomes. Further analysis along with the treatment outcomes will be presented at the ASH meeting in San Diego. Disclosures Rice: Novartis Pharma: Speakers Bureau; Alexion: Membership on an entity's Board of Directors or advisory committees, Other: Participation in registry studies; Apellis/Synergy: Other: Data Safety Monitoring Committee member; Ablynx: Other: Participation in multi-center research trial; Selexys: Other: Participation in multi-center research trial; Incyte: Other: Participation in multi-center research trial. Iyer:Genentech: Research Funding; Seattle Genetics: Research Funding; BMS: Research Funding; Incyte: Research Funding; Arog: Research Funding; Celgene: Research Funding.

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Hydroxyurea in the Early Management of Acute Myeloid Leukemia and Hyperleukocytosis.

Blood ◽

10.1182/blood.v110.11.4368.4368 ◽

2007 ◽

Vol 110 (11) ◽

pp. 4368-4368 ◽

Cited By ~ 3

Author(s):

Asmaa M. Quessar ◽

Nisrine R. Khoubila ◽

Raul C.U. Ribeiro ◽

Mohamed A. Rachid ◽

Saadia D. Zafad ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

High Risk ◽

Mortality Rate ◽

Induction Therapy ◽

Myeloid Leukemia ◽

Early Mortality ◽

Early Management ◽

The Mean ◽

Wbc Count ◽

Acute Myeloid

Abstract BACKGROUND: Patients with acute myeloid leukemia (AML) and hyperleukocytosis are at high risk of early mortality due to pulmonary, renal, and central nervous system complications. Leukapheresis and low-dose continuous infusion of cytarabine and hydroxyurea (HU) have been used but their advantages and limitations are not well characterized. The University hospital in Casablanca, Morocco has a limited number of beds, and hence admissions must be prioritized. Here we report the effects of HU on the white blood cell (WBC) count and early mortality rate of patients with hyperleukocytic AML. METHODS: Between April 2003 and December 2006, patients with AML were enrolled on the AML-MA2003 protocol (2 induction courses of cytarabine and daunorubicin and 2 postremission courses that include intermediate-dose cytarabine). Patients with AML and hyperleukocytosis (WBC count >50 x 109/L) were immediately started on HU (50 mg/kg/day orally x 4 days), regardless of hospital bed availability. Response was evaluated after 4 days of HU; patients were considered responders if >50% reduction of the initial WBC count was observed. RESULTS: Ninety of 260 (34.6%) patients enrolled had hyperleukocytosis. Three patients were excluded, induction therapy started on the day of admission. Therefore, 87 patients (48 females, 39 males) were evaluable. The mean age was 32 years (range, 2–60); 29% were children (ages 2–20 years). The mean initial WBC count was 104x109/L (range 50–260 x109/L); 37 (42.5%) patients had WBC counts > 100x109/L. The French-American-British subtypes were M1 (45%), M2 (26%), M4 (12%), M5 (7%), and M0, M3, M6 and M7 (2.5% each); 5 cases were unclassified. Karyotypes determined for 65/87 cases revealed 13 (20%) favorable karyotypes [9 had the t(8;21); 3 had inv16; 1 had the t(15;17)], 30 (46%) intermediate-risk karyotypes, including normal karyotypes, and 22 (34%) unfavorable-risk karyotypes. Sixty-two (71%) patients were classified as responders. In an additional 3, the WBC count was reduced 25%–50%. In 22 (25%) patients, including 4 whose WBC counts increased, HU showed no cytoreductive effect. The mean WBC count after 4 days of HU was 24 x 109/L (range, 1.5–125 x109/L); 15 (17%) patients’ WBC counts remained >100x109/L. Four patients developed acute tumor lysis syndrome (TLS) (hyperuricemia and renal dysfunction) in response to HU. There were 5 (8%) early deaths (mean, 7 days after the start of HU; range, 4–14 days). All 5 patients had WBC counts > 100x109/L at diagnosis, and only 1 was a responder. This mortality rate does not differ from that (9%) observed among the 170 protocol patients who did not have hyperleukocytosis. Causes of death included infection (n=1), pulmonary and CNS leukostasis (n=1 each), TLS (renal failure and hyperkalemia, n=1), and intracranial hemorrhage (n=1). Among several factors (age, sex, FAB type, karyotype, WBC counts), only WBC count of ≤ 100x109/L was significantly associated with response to HU (P=0.01). The complete remission rate after first course of induction therapy was 43.5% for responders and 16% for non-responders (P=0.02). CONCLUSION: HU given orally for 4 days rapidly reduces the WBC count in pediatric and adult AML with hyperleukocytosis. The early mortality rate in this high-risk group treated with HU compares favorably with rates reported for similar patients. It remains to be determined whether initial response to HU is associated with overall outcome in AML.

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