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Blood, Vol. 95 No. 1 (January 1), 2000:
pp. 72-77
Effect of time to complete remission on subsequent survival and
disease-free survival time in AML, RAEB-t, and RAEB
Elihu H. Estey,
Yu Shen, and
Peter F. Thall
From the Departments of Leukemia and Biomathematics, University of
Texas M. D. Anderson Cancer Center, Houston, TX.
The authors examined the relationship between the time required to
enter complete remission (CR) after a first course of chemotherapy for
newly diagnosed acute myeloid leukemia (AML), refractory
anemia with excess blasts in transformation (RAEB-t), or refractory
anemia with excess blasts (RAEB). They also examined subsequent
survival time and disease-free survival time after accounting for
cytogenetic status, age, and treatment. The data set consisted of 1101 patients with these diagnoses treated at the M. D. Anderson
Cancer Center between 1980 and 1996 for whom outcomes were established
after first-course therapy. Of the 1101 patients, 740 (67%) were in CR
after this time; 508 of these 740 (69%) have died (80% had disease
recurrence before death). The authors used the parametric model of Shen
and Thall to estimate, in particular, TC (time to CR),
TC,D (time from CR to death = residual survival after
CR), and TC,R (residual disease-free survival [DFS] after
CR) as functions of the covariates noted above and to estimate the
dependence of TC,D and TC,R on TC.
There was a strong inverse association between TC and both
TC,D and TC,R (P < .001 for both)
that was independent of cytogenetic status, age, or treatment. The
residual survival time of patients who required >50 days to enter CR
was closer to the residual survival time of resistant patients than to
that of patients known to be in CR within approximately 30 days of the
start of treatment. Time to CR is an independent predictor of residual
survival and disease-free survival in patients with newly diagnosed AML
who achieve CR after 1 course of chemotherapy. (Blood.
2000;95:72-77)
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