{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T08:10:11Z","timestamp":1756800611829,"version":"3.44.0"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100002429","name":"Amgen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002429","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Refractory acute myeloblastic leukemia (AML) is poorly studied. In this study, we characterized primary refractory AML and investigated treatment and outcome in a population\u2010based setting. Based on all AML patients receiving intensive induction therapy at 12 Swedish hospitals from 2011 to 2018 (<jats:italic>N<\/jats:italic>\u2009=\u20091221), we identified 306 patients that failed to achieve composite complete remission (CRc) after first\u2010line therapy. Two\u2010hundred\u2010sixteen (71%) of these patients received salvage treatment with intensive chemotherapy (ICT), of which 126 (58%) achieved CRc and 85 (39%) underwent allogeneic stem cell transplantation (HSCT). One\u2010 and 3\u2010year overall survival (OS) in patients receiving salvage ICT were 56.8% and 28.9%, respectively. Secondary AML and adverse ELN risk were associated with worse OS after salvage ICT, while fludarabine\u2010based FAIDA versus amsacrine\u2010based ACE salvage and HSCT were associated with better OS. Three\u2010year OS after first or second salvage chemotherapy, followed by HSCT were 55% and 71%, respectively. Refractory patients responding to salvage ICT showed only a nonsignificant trend toward inferior OS compared to patients in CRc after the first cycle. In conclusion, refractory AML patients eligible for further intensive therapy have a reasonable chance of obtaining remission and long\u2010term survival when followed by HSCT. The results can serve as a basis for evaluation of new treatments in refractory AML.<\/jats:p>","DOI":"10.1111\/ejh.70009","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T08:59:41Z","timestamp":1753347581000},"page":"423-432","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Second\u2010 and Third\u2010Line Salvage Chemotherapy Followed by Allogeneic Stem Cell Transplantation Leads to High Survival Rates in Primary Refractory <scp>AML<\/scp>\u2014A Population\u2010Based Study"],"prefix":"10.1111","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5271-1321","authenticated-orcid":false,"given":"Markus","family":"Liew\u2010Littorin","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Hematology \u00d6rebro University Hospital  \u00d6rebro Sweden"},{"name":"School of Medical Sciences, \u00d6rebro University  \u00d6rebro Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linn","family":"Deleskog\u2010Sp\u00e5ngberg","sequence":"additional","affiliation":[{"name":"Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Deneberg","sequence":"additional","affiliation":[{"name":"Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judit","family":"Janosi","sequence":"additional","affiliation":[{"name":"G\u00e4vle County Hospital  G\u00e4vle Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1782-4423","authenticated-orcid":false,"given":"Vladimir","family":"Lazarevic","sequence":"additional","affiliation":[{"name":"Department of Hematology, Oncology and Radiation Physics Sk\u00e5ne University Hospital  Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustav","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Uppsala University  Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aristea","family":"Papageorgiou","sequence":"additional","affiliation":[{"name":"Halmstad County Hospital  Halmstad Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8853-1863","authenticated-orcid":false,"given":"Anna","family":"Robelius","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Uppsala University  Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lovisa","family":"Vennstr\u00f6m","sequence":"additional","affiliation":[{"name":"Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gunnar","family":"Juliusson","sequence":"additional","affiliation":[{"name":"Department of Hematology, Oncology and Radiation Physics Sk\u00e5ne University Hospital  Lund Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bertil","family":"Uggla","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology \u00d6rebro University Hospital  \u00d6rebro Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"H\u00f6glund","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Uppsala University  Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00f6ren","family":"Lehmann","sequence":"additional","affiliation":[{"name":"Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Medical Sciences Uppsala University  Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(19)30150-0"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1902688"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40487-024-00262-x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30157-1"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2012971"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-07-296392"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31370"},{"issue":"4","key":"e_1_2_9_9_1","first-page":"124","article-title":"Outcomes of Patients With Relapsed or Refractory Acute Myeloid Leukemia: A Population\u2010Based Real\u2010World Study","volume":"10","author":"Brandwein J. M.","year":"2020","journal-title":"American Journal of Blood Research"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2022.106946"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-018-3304-y"},{"issue":"4","key":"e_1_2_9_12_1","first-page":"325","article-title":"A Systematic Literature Review of Disease Burden and Clinical Efficacy for Patients With Relapsed or Refractory Acute Myeloid Leukemia","volume":"11","author":"Oliva E. N.","year":"2021","journal-title":"American Journal of Blood Research"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2022016867"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2024.2363430"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2017.23"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-021-03821-1"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.23908"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-08-733196"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.32.8500"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdv205"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2024.107468"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2023.2253480"},{"issue":"1","key":"e_1_2_9_23_1","first-page":"72","article-title":"Fludarabine, Cytarabine, and Idarubicin With or Without Venetoclax in Patients With Relapsed\/Refractory Acute Myeloid Leukemia","volume":"109","author":"Shahswar R.","year":"2024","journal-title":"Haematologica"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13010034"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.47.4874"}],"container-title":["European Journal of Haematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ejh.70009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T07:51:52Z","timestamp":1756799512000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ejh.70009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,24]]},"references-count":24,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/ejh.70009"],"URL":"https:\/\/doi.org\/10.1111\/ejh.70009","archive":["Portico"],"relation":{},"ISSN":["0902-4441","1600-0609"],"issn-type":[{"type":"print","value":"0902-4441"},{"type":"electronic","value":"1600-0609"}],"subject":[],"published":{"date-parts":[[2025,7,24]]},"assertion":[{"value":"2025-04-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}