TY - JOUR AU - Paul Ferguson, AU - Robert K. Hills, AU - Angela Grech, AU - Sophie Betteridge, AU - Lars Kjeldsen, AU - Michael Dennis, AU - Paresh Vyas, AU - Anthony H. Goldstone, AU - Donald Milligan, AU - Richard E. Clark, AU - Nigel H. Russell, AU - Charles Craddock, PY - 2016/10/31 Y2 - 2024/03/28 TI - An operational definition of primary refractory acute myeloid leukemia allowing early identification of patients who may benefit from allogeneic stem cell transplantation JF - Haematologica JA - haematol VL - 101 IS - 11 SE - Articles DO - 10.3324/haematol.2016.148825 UR - https://haematologica.org/article/view/7879 SP - 1351-1358 AB - Up to 30% of adults with acute myeloid leukemia fail to achieve a complete remission after induction chemotherapy - termed primary refractory acute myeloid leukemia. There is no universally agreed definition of primary refractory disease, nor have the optimal treatment modalities been defined. We studied 8907 patients with newly diagnosed acute myeloid leukemia, and examined outcomes in patients with refractory disease defined using differing criteria which have previously been proposed. These included failure to achieve complete remission after one cycle of induction chemotherapy (RES), less than a 50% reduction in blast numbers with >15% residual blasts after one cycle of induction chemotherapy (REF1) and failure to achieve complete remission after two courses of induction chemotherapy (REF2). 5-year overall survival was decreased in patients fulfilling any criteria for refractory disease, compared with patients achieving a complete remission after one cycle of induction chemotherapy: 9% and 8% in patients with REF1 and REF2 versus 40% (P