scholarly journals The Outcome of Sibling and Unrelated Donor Allogeneic Stem Cell Transplantation in Adult Patients with Acute Myeloid Leukemia in First Remission Who Were Initially Refractory to First Induction Chemotherapy

2006 ◽  
Vol 12 (3) ◽  
pp. 293-300 ◽  
Author(s):  
Gordon Cook ◽  
Richard E. Clark ◽  
Charles Crawley ◽  
Stephen Mackinnon ◽  
Nigel Russell ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Induction Chemotherapy ◽  
Allogeneic Stem Cell Transplantation ◽  
Myeloid Leukemia ◽  
Unrelated Donor ◽  
First Remission ◽  
Acute Myeloid

Outcome of Patients with Primary Refractory Acute Myeloid Leukemia (AML) Undergoing Myeloablative Allogeneic Stem-Cell Transplantation (alloSCT) from HLA-Identical Sibling: Favorable Outcome in a Subset of Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3022-3022
Author(s):  
Jordi Esteve ◽  
Myriam Labopin ◽  
Gerhard Ehninger ◽  
Athanasios Fassas ◽  
Jurgen Finke ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Myeloid Leukemia ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Induction Chemotherapy ◽  
Allogeneic Stem Cell Transplantation ◽  
Myeloid Leukemia ◽  
Wbc Count ◽  
Acute Myeloid

Abstract The prognosis of patients with acute myeloid leukemia (AML) failing to standard induction chemotherapy is very poor, and only a minority of such patients will be ultimately cured after salvage chemotherapy. The precise role of allogeneic stem cell transplantation (alloSCT) in primary refractory AML has not been extensively assessed and it is not commonly indicated in this setting. In this regard, we analyzed the outcome and eventual prognostic factors in a series of adult patients who received an undepleted allograft from an HLA-identical sibling using a myeloablative conditioning for a primary refractory “de novo” AML (i.e., patients who never achieved complete response (CR) before transplantation). Overall, 361 patients (median age: 39; range: 17–71; 60% male) fulfilling these criteria and registered to the EBMT during the period 1990–2004 were included in the study. Median interval from diagnosis to transplant was 132 days (24–360) and the median number of induction courses was 2 (1–5). Percentage of bone marrow (BM) blasts at time of SCT was 20% (0–93). Most patients with available information (n=126, 35%) harbored an intermediate-risk cytogenetics (67%). Stem-cell source was peripheral blood (PB) in 61% of cases, and conditioning regimen did not contain TBI in 59% of the procedures. Following alloSCT, 218 patients (60%) achieved CR and 143 failed to respond. After a median follow-up of 26 months, 3 and 5-year overall survival was 24±2% and 19±3%, respectively. Of note, among the subset of patients achieving CR after alloSCT, overall survival and leukemia-free survival at 3-year was 37±3% and 33±3%, respectively, whereas none of those patients failing to alloSCT survived further than 10 months after transplant. The comparison of main characteristics between subgroups of patients according to response attained after alloSCT only disclosed a shorter interval from diagnosis (126 vs. 143 days, p=0.01) in the subset of responding patients. Moreover, a lower WBC count at diagnosis, inferior to median value (3-yr OS: 27±6% vs. 15±5%; RR: 2.08, 95% CI: 1.05–4.17; p=0.03), and a BM involvement of blast cells <20% at time of transplantation (3-yr OS: 35±8% vs. 10±5%; RR: 2.13, 95% CI: 1.12–4; p=0.02) were the only variables associated to a longer survival. In conclusion, allogeneic SCT is a reasonable alternative for a subset of patients with AML failing to primary induction chemotherapy who have an available HLA-identical sibling. Thus, a low WBC count at diagnosis and a low degree of BM infiltration at transplant were predictive of a more favorable outcome in the subgroup of 56 patients with this information available. Confirmation of this finding in a larger proportion of patients would be helpful to identify those patients with AML who could benefit from an allogeneic transplantation in a refractory status.

scholarly journals Comparison of Allogeneic Stem Cell Transplantation for Transformed Acute Myeloid Leukemia Derived from MDS, CMML or MPN. a Report of the Chronic Malignancies Working Party of EBMT

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3499-3499 ◽  
Author(s):  
Nicolaus Kröger ◽  
Diderik-Jan Eikema ◽  
Liesbeth De Wreede ◽  
Anja van Biezen ◽  
Dietrich W. Beelen ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Myeloid Leukemia ◽  
Research Funding ◽  
Conditioning Regimen ◽  
Unrelated Donor ◽  
Acute Myeloid

Abstract Introduction Myelodysplastic syndromes (MDS), myeloproliferative neoplasms (MPN) and chronic myelomonocytic leukemia (CMML) can progress to acute myeloid leukemia (transformed AML). The aim of this EBMT registry study was to compare 3 year outcome in patients with transformed AMLwho received allogeneic stem cell transplantation according to the primary disease. Patients and Methods Within the European Society of Blood and Marrow Transplantation (EBMT) registry, we found 4214 patients (female: 39%, male: 61%) with transformed acute myeloid leukemia, who received allogeneic stem cell transplantation between 2000 and 2014. The primary disease was MDS (n=3541), CMML (n=251) or MPN (n=422). The median age at transplantation was 58 years (range, 18-79) and 59% received a reduced intensity (RIC) conditioning regimen. The majority of the patients received stem cells from an unrelated donor (62%) and 50% were in complete remission at time of transplantation. Within the different groups of primary diseases, MDS patients were more often in CR (53%) than patients with CMML (47%) or MPN (43%). RIC was also more frequently used in MDS patients (65%), than in CMML (64%) and MPN patients (58%). Results After a median follow up of 46.5 months , the estimated 3 year relapse-free (RFS) and overall survival (OS) for the entire group was 36% (95%CI: 34-38%) and 40% (95% CI: 33-42%), respectively.The cumulative incidence of relapse and non-relapse mortality (NRM) was 37% (95% CI: 35-39%) and 27% (95% CI: 26-29%), respectively. In a univariate analysis, patients with primary disease MDS had a significant better 3 year OS and RFS (41% and 37%) than patients with CMML (36% and 30) and MPN (32% and 25%) (p<0.001), due to a significant lower incidence of relapse at 3 years (35% vs 43% vs 50%, p<0.001). Other risk factors for worse OS were higher patient's age (>60 years), unrelated donor, not being in complete remission and low Karnofsky index (< 80%), while T-cell depletion, intensity of the conditioning regimen and TBI as conditioning regimen did not influence survival significantly. In a multivariate analysis for OS beside age >60 years (HR 1.31; 95% CI: 1.13-1.52, p<0.001), unrelated donor (HR 1.12; 95% CI: 1.04-1.23, p=0.005), CMV +/- constellation (HR 1.13; 95%CI: 0.99-1.28, p=0.05), Karnofsky index > 80 (HR 0.66; 95% CI: 0.58-0.74, p< 0.001), non CR (HR 1.50; 95% CI: 1.38-1.63, p<0.001) PBSC as stem cell source (HR 0.86; 95% CI:0.75-0.97, p=0.02) and transformed AML from MPN (HR 1.24; 95% CI: 1.085-1.41, p=0.002) remained a significant factor in comparison to transformed AML from MDS, while outcome of transformed AML from CMML did not reach statistical significance in comparison to MDS (HR 1.10; 95% CI: 0.933-1.30, p=0.25) Conclusion This large EBMT registry study demonstrates that the primary underlying disease influence outcome of transformed acute myeloid leukemia in addition to other risk factors. Disclosures Kröger: Novartis: Honoraria, Research Funding. Maertens:Merck Sharp & Dohme: Consultancy, Honoraria, Research Funding, Speakers Bureau; Gilead: Consultancy, Honoraria, Speakers Bureau; Pfizer: Consultancy, Honoraria, Research Funding, Speakers Bureau; Astellas: Consultancy, Speakers Bureau; Amgen: Consultancy. Kobbe:Jansen: Honoraria, Other: travel support; Celgene: Honoraria, Other: travel support, Research Funding.

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