Bridging Strategies to Allogeneic Transplant for Older AML Patients

Hecker, Judith; Miller, Isabella; Götze, Katharina; Verbeek, Mareike

doi:10.3390/cancers10070232

Cited by 8 publications

(5 citation statements)

References 98 publications

(123 reference statements)

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“…A study by the European Blood and Marrow Transplantation (EBMT) group showed cumulative incidence of relapse after allo-SCT 32% ± 1% among AML patients and the longer intervals from transplant to relapse, low bone marrow tumor burden at relapse, and the absence of aGVHD were identified as prognostic factors associated with survival improvement in these patients 52 . Similar to prior reports we observed poor survival following AML relapse after allo-SCT 49 , 53 . OS had a strong relationship with leukemia recurrence (P<0.001).…”

Section: Discussionsupporting

confidence: 91%

“…In the current study, 97% of patients were age <40 years at the time of allo-SCT. No significant relationship between age at transplant time and survival was detected (P=0.73) in the study, It might be due to overall young age of study group which is consistent with the similar study by Shokouhi et al on 587 AML patients with a mean age of 27.27 ± 12.45 years at transplant time 49 . Most studies have shown that people over the age of 60 years are less likely to survive than younger people 50 , 51 .…”

Section: Discussionsupporting

confidence: 89%

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Survival of Patients with Acute Myeloid Leukemia after Allogeneic Stem Cell Transplantation: An Experience in Developing Country

Mehdizadeh¹,

Bolourian²,

Zamani³

et al. 2022

IJHOSCR

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Background: Allogeneic stem cell transplantation (allo-SCT) is the highest potential treatment for long-term survival as post-remission therapy for acute myeloid leukemia (AML). The aim of this study was to estimate the overall survival (OS) of patients with AML after allo-SCT and to identify the factors affecting them as a prognostic factor for the survival of patients. Material and Methods: In this retrospective cohort study, data of patients with AML who underwent allo-SCT at Taleghani bone marrow transplantation and cell therapy center in Tehran, Iran, from May 2009 to September 2016 were used. A total of 101 patients were enrolled and death time was considered as a failure event for them. Kaplan-Meier method, log-Rank tests, and Cox proportional hazard model were used to evaluate OS and to identify the risk factors of patient’s survival. The SPSS software version 21 was used for the analysis of data and P<0.05 was considered as a significant level. Results: Of 101 patients with AML, 49 (48.5%) were males. The median age at allo-SCT was 32.76 years and 42 patients (41.6%) died. The 5-year OS and disease-free survival (DFS) was 56% (95%CI: 51-61%) and 52% (95%CI: 57-47%), respectively. Multivariate analysis by Cox regression indicated that OS has a significant relationship with primary WBC count and relapse (P=0.001). Conclusion: Our results showed that allo–SCT has nearly the same outcome in developing countries and the WBC count and relapse are effective factors on the chance of survival in AML patients after allo-SCT.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 89%

Survival of Patients with Acute Myeloid Leukemia after Allogeneic Stem Cell Transplantation: An Experience in Developing Country

Mehdizadeh¹,

Bolourian²,

Zamani³

et al. 2022

IJHOSCR

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“…The role of HMAs is well-established in the frontline treatment of older patients with AML, including bridging to transplant [29], while no randomized trials have been performed in refractory or relapsed disease. In the absence of prospective studies, different retrospective observations have demonstrated the potential utility of either AZA or DAC.…”

Section: Intensive Salvage Chemotherapy and Hypomethylating Agentsmentioning

confidence: 99%

Current Therapeutic Results and Treatment Options for Older Patients with Relapsed Acute Myeloid Leukemia

Ferrara¹,

Lessi

Vitagliano³

et al. 2019

Cancers

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Considerable progress has been made in the treatment of acute myeloid leukemia (AML). However, current therapeutic results are still unsatisfactory in untreated high-risk patients and poorer in those with primary refractory or relapsed disease. In older patients, reluctance by clinicians to treat unfit patients, higher AML cell resistance related to more frequent adverse karyotype and/or precedent myelodysplastic syndrome, and preferential involvement of chemorefractory early hemopoietic precursors in the pathogenesis of the disease further account for poor prognosis, with median survival lower than six months. A general agreement exists concerning the administration of aggressive salvage therapy in young adults followed by allogeneic stem cell transplantation; on the contrary, different therapeutic approaches varying in intensity, from conventional salvage chemotherapy based on intermediate–high-dose cytarabine to best supportive care, are currently considered in the relapsed, older AML patient population. Either patients’ characteristics or physicians’ attitudes count toward the process of clinical decision making. In addition, several new drugs with clinical activity described as “promising” in uncontrolled single-arm studies failed to improve long-term outcomes when tested in larger randomized clinical trials. Recently, new agents have been approved and are expected to consistently improve the clinical outcome for selected genomic subgroups, and research is in progress in other molecular settings. While relapsed AML remains a tremendous challenge to both patients and clinicians, knowledge of the molecular pathogenesis of the disease is fast in progress, potentially leading to personalized therapy in most patients.

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“…In AML, they are primarily a treatment option for patients not eligible for intensive induction. They can also be used as bridging to HCT in selected subgroups of patients [117,118], and can potentially have a place as maintenance treatment after remission in elderly patients ineligible for HCT [119]. Treatment with HMAs in patients with s-AML is an appealing option due of the overrepresentation of typical adverse risk aberrations such as complex or monosomal karyotypes, abnormalities in chromosome 5, 7 and 17, and TP53 mutations that might predict response to HMAs [6,120,121].…”

Section: Hypomethylating Agentsmentioning

confidence: 99%

Secondary Acute Myeloid Leukemia and the Role of Allogeneic Stem Cell Transplantation in a Population-Based Setting

Nilsson

Hulegårdh

Garelius

et al. 2019

Biology of Blood and Marrow Transplantation

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Secondary acute myeloid leukemia (s-AML) refers to patients with either therapy-related AML (t-AML), that is, AML after treatment with chemo-and/or radiation for a prior disease, or AML progressing from an antecedent hematologic disorder (AHD-AML), typically a myelodysplastic syndrome (MDS) or a myeloproliferative neoplasm. Patients with s-AML present with higher rates of adverse cytogenetic aberrations and higher frequencies of adverse mutations and, subsequently, respond worse to therapy, and have poorer outcome compared to de novo AML. To identify clinical and molecular factors that may improve prognostication is therefore of importance to guide clinical decision-making. The general aim of this thesis was to broaden the real-world knowledge of s-AML, regarding disease properties and outcome, using population-based registries, and additionally to investigate the importance of mutations in the transformation from MDS to AML. The research papers presented herein cover mutational screening in MDS and s-AML (study I), general characteristics and outcome of s-AML (study II), the role of allogeneic hematopoietic cell transplantation (HCT) in patients with s-AML (study III), and the epidemiology and treatment outcome specifically for t-AML (study IV). långtidsöverlevare utan transplantation. Att genomgå transplantation i s.k. första remission var överlägset behandling med enbart cytostatika. Studie IV fokuserade på patienter med terapirelaterad AML. Data från svenska AMLregistret på 686 patienter kombinerades med data från Socialstyrelsens cancerregister och Svensk Reumatologis Kvalitetsregister. Huvudsakliga fynd var att incidensen av t-AML tydligt ökar över tid och att andelen terapirelaterad AML av AML-fallen totalt blev allt större. Överlevnaden vid terapirelaterad AML var generellt mycket dyster, men i vissa genetiska undergrupper var den bättre och jämförbar med patienter med motsvarande genetisk riskprofil som nyinsjuknat i AML. Sammanfattningsvis är sekundär-AML en ovanlig sjukdom som är mycket svårbehandlad. Nya läkemedel kommer att krävas för att förbättra överlevnaden, men förhoppningsvis kommer sådana att utvecklas hand i hand med den ökade förståelsen av sjukdomsbiologin. Behandlingen av AML har i stort sett varit oförändrad i årtionden, men nyligen har läkemedel som bl.a. utnyttjar specifika genetiska avvikelser introducerats. Inom andra cancerformer har immun-och cellterapi fått stort genomslag och dessa är potentiellt användbara även mot AML. För gruppen med sekundär-AML är det därför av stor betydelse att sjukdomshistorik, hög ålder och samsjuklighet inte utgör hinder för deltagande i kommande läkemedelsstudier. LIST OF SCIENTIFIC PAPERS I. High-throughput mutational screening adds clinically important information in myelodysplastic syndromes and secondary or therapy-related acute myeloid leukemia.

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Bridging Strategies to Allogeneic Transplant for Older AML Patients

Cited by 8 publications

References 98 publications

Survival of Patients with Acute Myeloid Leukemia after Allogeneic Stem Cell Transplantation: An Experience in Developing Country

Survival of Patients with Acute Myeloid Leukemia after Allogeneic Stem Cell Transplantation: An Experience in Developing Country

Current Therapeutic Results and Treatment Options for Older Patients with Relapsed Acute Myeloid Leukemia

Secondary Acute Myeloid Leukemia and the Role of Allogeneic Stem Cell Transplantation in a Population-Based Setting

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