A long-term follow-up report on allogeneic stem cell transplantation for patients with primary refractory acute myelogenous leukemia: impact of cytogenetic characteristics on transplantation outcome

Fung, Henry C.; Stein, Anthony S.; Slovak, Marilyn L.; O’Donnell, Margaret; Snyder, David S.; Cohen, Sandra; Smith, David; Krishnan, Amrita; Spielberger, Ricardo; Bhatia, Ravi; Bhatia, Smita; Falk, Peter; Molina, Arturo; Nademanee, Auayporn; Parker, Pablo; Rodríguez, Roberto; Rosenthal, Joseph; Sweetman, Robert; Kogut, Neil; Sahebi, Firoozeh; Popplewell, Leslie; Vora, Nilesh; Somlo, George; Margolin, Kim; Chow, Warren; Smith, Eileen; Forman, Stephen J.

doi:10.1016/j.bbmt.2003.08.004

Cited by 115 publications

(77 citation statements)

References 16 publications

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“…Previous studies reported OS rates of 20-30% in refractory AML using standard conditioning regimens for HCT. 21,22 In our study, the incidence of relapse at 5 years was low (32% for all patients). This is comparable with published reports in advanced AML and MDS patients, or AML patients in remission with unfavorable cytogenetics.…”

Section: Discussioncontrasting

confidence: 49%

Improved outcome in relapsed and refractory myeloid malignancies for unrelated vs related donor allogeneic peripheral blood-derived hematopoietic cell transplantation

Denz

Bertz

Ihorst

et al. 2010

Bone Marrow Transplant

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There are limited data on the comparison of unrelated vs related peripheral blood-derived hematopoietic cell transplantation (HCT) in patients with AML and its implications in high-risk patients. In this single-center retrospective study, we report on a total of 92 consecutive patients with AML (n ¼ 87) or myelodysplastic syndrome (MDS; n ¼ 5), who were treated between 1996 and 2006 with a uniform preparative regimen of BU and CY and peripheral bloodderived HCT from related (n ¼ 46) or unrelated donors (n ¼ 46). At transplantation, 45 patients were in CR, 11 were untreated and 36 had relapsed or refractory disease. Median follow-up was 864 days after transplant (range 24-3798). At 5 years after HCT, cumulative incidences for relapse (32% of all patients) and nonrelapse mortality (NRM; 17%) were low. The 5-year relapse-free survival (RFS) and OS rates were 36 and 45% for related and 47 and 57% for unrelated patients, respectively (RFS P ¼ 0.43; OS P ¼ 0.28). High-risk patients with an unfavorable remission status before HCT benefited more from unrelated HCT than related HCT, showing a significantly better 5-year RFS of 46% (95% confidence interval (CI) 27-65) vs 22% (95% CI 4-40) (P ¼ 0.04). Unrelated HCT benefited high-risk AML patients with an unfavorable remission status better than related HCT.

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Section: Discussioncontrasting

confidence: 49%

Improved outcome in relapsed and refractory myeloid malignancies for unrelated vs related donor allogeneic peripheral blood-derived hematopoietic cell transplantation

Denz

Bertz

Ihorst

et al. 2010

Bone Marrow Transplant

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“…Older individuals with myeloid diseases also have high risk cytogenetic phenotypes and increased multidrug resistance gene expression [1][2][3]; hence they are less likely cured with chemotherapy alone. Allogeneic hematopoietic stem cell transplantation (HSCT) is potentially curative with a reported disease-free survival (DFS) of 30-50% [4][5][6][7][8][9]. In MDS, HSCT is the only therapy known to improve survival [10].…”

Section: Introductionmentioning

confidence: 99%

Reduced intensity compared with high dose conditioning for allotransplantation in acute myeloid leukemia and myelodysplastic syndrome: A comparative clinical analysis

et al. 2007

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We evaluated the efficacy of hematopoietic stem cell transplantation (HSCT) using reduced intensity (RI) vs. myeloablative (MA) conditioning for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome. Thirty two patients (median age 54) who underwent a RI HSCT (2000HSCT ( -2003 were compared with 187 patients (median age 39) who received a MA transplant (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003). Neutrophil engraftment was more rapid in the RI group (median 11.5 vs. 21 days). Platelet recovery was similar and graft failure was infrequent. The incidence of graft-versus-host disease (GVHD) and treatment-related mortality was similar though relapse was more frequent after RI conditioning (RR 2.2 [95% CI 5 1.1-4.6] P 5 0.03). At 2 years, disease-free survival (DFS) (31% vs. 30%, P > 0.1) and overall survival (33% vs. 35%, P > 0.1) were comparable between RI and MA groups, respectively. We suggest that RI allografts can yield satisfactory DFS both for older as well as younger patients with pre-existing comorbidities, who are ineligible for MA allografts. Advances in GVHD management and new approaches for relapsed or refractory disease are necessary to improve these outcomes. Am. J. Hematol. 82:867-872, 2007. V

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“…Fung et al [5] reviewed the records of 68 patients who consecutively underwent transplantation at the City of Hope Cancer Center with allogeneic SCT for primary refractory AML between July 1978 and August 2000. Allogeneic SCT can cure approximately one third of patients with primary refractory AML.…”

Section: Discussionmentioning

confidence: 99%

Allogeneic stem cell transplantation can improve outcome of AML patients without complete cytogenetic response after induction and consolidation treatment

Dvořák¹,

Lysák²,

Vokurka³

et al. 2015

neo

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Our retrospective analysis was performed on 376 consecutive patients diagnosed with AML. A total of 256 (68%) were treated with standard "7+3" induction and high-dose cytarabine and mitoxantrone containing "4+3" consolidation/ intensification regimens. Our study focused on patients with presumably very poor prognosis -patients, who did not achieve complete cytogenetic remission (CRc). Twenty-five AML patients without CRc were further analysed for clinical and laboratory parameters. Firstly, the subgroups with or without morphologic CR were compared. Similar cytogenetic abnormalities were observed in both with myelodysplasia related changes being the most common. Complex karyotype with deletion of 5q constituted approximately a third of all karyotypes in both subgroups. There were 1 patient with intermediate risk cytogenetics in the subgroup without morphologic CR and 5 patients in the subgroup with morphologic CR. Interestingly, in 4/25 patients subclones were diminished by the chemotherapy treatment, however cytogenetically less advanced clones proliferated. Secondly, transplanted or nontransplanted patients were analysed. Allogeneic stem cell transplantation (allo-SCT) was found to be the only curative treatment for patients without CRc after 7+3 and 4+3 regimens. In our cohort, 40% of the patients, who underwent allo-SCT, are alive. Importantly, 67% of the patients, who died after allo-SCT, died of causes unrelated to progression of AML. Nonrelapse mortality is therefore one of the fields where survival could be further improved.

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A long-term follow-up report on allogeneic stem cell transplantation for patients with primary refractory acute myelogenous leukemia: impact of cytogenetic characteristics on transplantation outcome

Cited by 115 publications

References 16 publications

Improved outcome in relapsed and refractory myeloid malignancies for unrelated vs related donor allogeneic peripheral blood-derived hematopoietic cell transplantation

Improved outcome in relapsed and refractory myeloid malignancies for unrelated vs related donor allogeneic peripheral blood-derived hematopoietic cell transplantation

Reduced intensity compared with high dose conditioning for allotransplantation in acute myeloid leukemia and myelodysplastic syndrome: A comparative clinical analysis

Allogeneic stem cell transplantation can improve outcome of AML patients without complete cytogenetic response after induction and consolidation treatment

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