Factors affecting long‐term outcome after allogeneic haematopoietic stem cell transplantation for acute myelogenous leukaemia: a retrospective study of 172 adult patients reported to the Austrian Stem Cell Transplantation Registry

Summary:The impact of disease burden on the outcome of patients with acute myeloid leukemia (AML) undergoing allogeneic stem cell transplantation (SCT) has not been well defined. Data from several retrospective series suggest that overt leukemia at the time of transplant increases the risk of relapse. We reviewed the outcomes of 68 consecutive adults with AML (n ¼ 60) or myelodysplastic syndromes (MDS) (n ¼ 8) who received an allogeneic SCT at the University of Chicago between May 1986 and October 2002 to confirm the importance of currently recognized risk factors for overall survival (OS) and progression-free survival (PFS). In addition, we wanted to determine whether quantification of residual disease by blast percentage or cytogenetic abnormalities at the time of SCT was correlated with outcome. AML subtypes based on the FAB classification were as follows:Cytogenetic analysis was available from 52 patients. Using standard morphologic criteria, 34 patients were in complete remission (CR) and 34 had visible leukemia present. The majority of donors were HLA-identical siblings (n ¼ 55). In all, 56 patients received myeloablative conditioning regimens and 12 received a reduced-intensity, fludarabine-based conditioning regimen. OS and PFS times were 7.1 months (95% CI, 4.8-10.4) and 5.1 months (95% CI, 3.2-7.8), respectively. Median follow-up from SCT was 4.6 years (range, 0.6-17.0) for survivors. In multivariate analysis, the following factors were found to be associated with worse survival: (1) increased percentage of blasts in the bone marrow at the time of SCT, (2) presence of acute graft-versus-host disease, (3) mismatched donor, (4) Zubrod performance score of X2, and (5) age X45 years. We also found a trend towards improved outcome among patients in cytogenetic remission as compared to those who had residual cytogenetic abnormalities and those in overt relapse. These data support an association between pre-transplant disease burden and poor outcome after SCT.Bone Marrow Transplantation (2005) 35, 965-970.

“…8,27,28 In the multivariate analysis for OS, age X45 years correlated with decreased survival. The risk of death increased by a factor of 1.57 (57%) per decade.…”

Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

Impact of disease burden at time of allogeneic stem cell transplantation in adults with acute myeloid leukemia and myelodysplastic syndromes

Kebriaei

Kline

Stock

et al. 2005

“…[2][3][4][5] Other currently recognized risk factors associated with a worse outcome include older age and development of acute or chronic GVHD. [6][7][8] The aim of this single-center retrospective study was to review the clinical characteristics and evaluate the potential predictors of RFS and OS in unrelated vs sibling donor HCT. Therefore, we analyzed the data of 92 consecutive adult patients with AML and myelodysplastic syndrome (MDS) undergoing their first peripheral blood-derived HCT from related or unrelated donors at the University of Freiburg Medical Center between 1996 and 2006 after treatment with a uniform preparative regimen consisting of high-dose oral BU and CY.…”

Section: Introductionmentioning

confidence: 99%

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

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.

“…[25][26][27][28][29][30][31] It has been the practice of this center to use one-antigen HLA-mismatched donors for patients with both standard-and high-risk disease using the same NST conditioning regimen and GVHD prophylaxis as their counterparts from HLAidentical sibling donors. Anasetti et al 32 found that overall SV was not compromised in the 119 recipients of oneantigen HLA-mismatched BMT when compared to a cohort of 967 recipients of HLA-matched sibling transplants.…”

Section: Discussionmentioning

confidence: 99%

Significance of one human leukocyte antigen mismatch on outcome of nonmyeloablative allogeneic stem cell transplantation from related donors using the Mexican schedule

Ruíz‐Argüelles

López-Martı́nez

Manzano

et al. 2005

Summary:Using the Mexican approach to conduct nonablative stem cell transplantation (NST), we have prospectively performed 58 allografts in individuals with various malignant and nonmalignant hematological diseases using sibling donors, either HLA identical (6/6) or compatible, with one mismatch (5/6). When comparing allografts obtained from HLA identical (n ¼ 40) or compatible (n ¼ 18) siblings, respectively, the overall median survival was found to be 33 vs 8 months (Po0.01), the 52-month survival was 47 vs 38% (P40.2), the prevalence of acute graft-versus-host disease (GVHD) 57 vs 38%, that of chronic GVHD 25 vs 11% and the relapse rate 45 vs 55%. The two patients who failed to engraft were both 5/6 matches. Probably stemming from the low number of patients, and despite a trend toward worse results in patients allografted from HLA compatible (5/6) siblings, most differences in outcome were not significant. It seems that NST can be offered to individuals with either an HLA identical or a compatible sibling donor.