Retrospective Studies

A number of retrospective studies have described the outcome of combination chemotherapy for patients with AML in first relapse. At least five have included more than 100 patients (see Table 9.2).38-11 Most of these reports were summaries of multiple regimens and included a fairly wide range of categories of patients. In these five studies, the early death rate ranged from 8 to 32% and the CR rate varied from 30 to 51%. The duration of CR2 was in the range of 5-7.5 months, and the median survival in these trials was 4-10 months. While it is difficult to extract principles of treatment from these retrospective studies, they do provide a realistic sense of what can be expected with fairly standard chemotherapy. They also help confirm the influence of duration of CR on subsequent outcome and the influence of age. For example, in the study reported by Keating et al., the CR rate was 62% in those with a first CR of longer than 12 months versus 19% in those with a shorter first remission, and the CR rates were 36% in those younger than 60 versus 14% in those older than 60 years.9 While a number of other smaller retrospective studies have reported somewhat more encouraging results, the potential impact of patient selection and the biases imposed by the choice to report and publish these series is substantial, arguing that such studies should be interpreted with considerable caution.

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