Hematopoietic cell transplantation in first complete remission versus early relapse

Appelbaum, Frederick R.; Pearce, Suman

doi:10.1016/j.beha.2005.12.001

Cited by 24 publications

(7 citation statements)

References 11 publications

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“…This benefit is most obvious for patients with poor-risk cytogenetics, is less impressive for patients with intermediate-risk cytogenetics, and is lost for patients with good-risk cytogenetics (4–6). Together, these analyses suggest an important role of MRD HCT for many patients in CR1 (7–9). …”

Section: Introductionmentioning

confidence: 80%

Comparison of matched unrelated and matched related donor myeloablative hematopoietic cell transplantation for adults with acute myeloid leukemia in first remission

et al. 2010

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Hematopoietic cell transplantation (HCT) from a matched related donor (MRD) benefits many adults with acute myeloid leukemia (AML) in first complete remission (CR1). The majority of patients do not have such a donor, however, requiring use of an alternative donor if HCT is undertaken. We retrospectively analyzed 226 adult AML CR1 patients undergoing myeloablative unrelated donor (URD) (10/10 match, n=62; ≤9/10, n=29) or MRD (n=135) HCT from 1996–2007. Five-year estimates of overall survival (OS), relapse, and non-relapse mortality (NRM) were 57.9%, 29.7%, and 16.0%, respectively. Failure for each of these outcomes was slightly higher for 10/10 URD than MRD HCT, although statistical significance was not reached for any endpoint. The adjusted hazard ratios (HR) were 1.43 (0.89–2.30, p=0.14) for overall mortality, 1.17 (0.66–2.08, p=0.60) for relapse, and 1.79 (0.86–3.74, p=0.12) for NRM, respectively, and the adjusted odds ratio (OR) for grades 2–4 acute graft-versus-host disease was 1.50 (0.70–3.24, p=0.30). Overall mortality among 9/10 and 10/10 URD recipients was similar (adjusted HR=1.16 [0.52–2.61], p=0.71). These data indicate that URD HCT can provide long-term survival for CR1 AML; outcomes for 10/10 URD HCT, and possibly 9/10 URD HCT, suggest that this modality should be considered in the absence of a suitable MRD.

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Section: Introductionmentioning

confidence: 80%

Comparison of matched unrelated and matched related donor myeloablative hematopoietic cell transplantation for adults with acute myeloid leukemia in first remission

et al. 2010

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“…7,8,9 Unfortunately, less than 30% of adults will have an HLAmatched sibling donor. However, recent data suggest that outcomes after allogeneic HCT from fully matched unrelated donors seem to be similar to those after matched related donor transplantation.…”

Section: Journal Of Clinical Oncology O R I G I N a L R E P O R T V Omentioning

confidence: 99%

Frequency of Allogeneic Hematopoietic Cell Transplantation Among Patients With High- or Intermediate-Risk Acute Myeloid Leukemia in First Complete Remission

Mawad

Gooley

Sandhu

et al. 2013

JCO

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Purpose To determine the frequency of allogeneic hematopoietic cell transplantation (HCT) for patients with acute myeloid leukemia (AML) in first complete remission (CR1). Patients and Methods Between January 1, 2008, and March 1, 2011, 212 newly diagnosed patients with AML received treatment at our center. Ninety-five patients age less than 75 years with intermediate- or high-risk AML achieved a complete remission, and 21 patients achieved a morphologic remission with incomplete blood count recovery. Results Seventy-eight (67%; 95% CI, 58% to 76%) of 116 patients received HCT at a median of 2.8 months (range, 0.5 to 19 months) from their CR1 date. The median age was 57 years in both the HCT patient group (range, 18 to 75 years) and the non-HCT patient group (range, 24 to 70 years; P = .514). Between the HCT patients and the non-HCT patients, the mean Eastern Cooperative Oncology Group performance status was 1.1 compared with 1.5, respectively (P = .005), and the average HCT comorbidity score within 60 days of CR1 was 1.7 and 2.1, respectively (P = .68). Twenty-nine (76%) of 38 non-HCT patients were HLA typed, and matched donors were found for 13 of these 29 patients (34% of all non-HCT patients). The most common causes for patients not receiving transplantation in CR1 were early relapse (within 6 months) in 12 patients (32%), poor performance status in eight patients (21%), and physician decision in five patients (13%). Conclusion HCT can be performed in CR1 in the majority of patients with AML for whom it is currently recommended. The main barriers to HCT were early relapse and poor performance status, highlighting the need for improved therapies for patients with AML of all ages.

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“…[1][2][3] In an effort to reduce NRM, several groups have developed reduced-intensity conditioning (RIC) regimens, [4][5][6][7][8][9][10][11] which lead to engraftment of donor lymphoid and hematopoietic stem cells without the non-hematologic toxicities of traditional myeloablative transplants. [4][5][6][7][8][9][10][11][12][13] However, experience with RIC alloHSCT in AML and high-risk MDS is limited.…”

Section: Introductionmentioning

confidence: 99%

Comparable non-relapse mortality and survival after HLA-identical sibling blood stem cell transplantation with reduced or conventional-intensity preparative regimens for high-risk myelodysplasia or acute myeloid leukemia in first remission

Martino

Valcárcel

Brunet

et al. 2007

Bone Marrow Transplant

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We prospectively compared two strategies of allogeneic PBSCT from HLA-identical siblings in adults with poor-risk AML or myelodysplastic syndrome with 45% marrow blasts in an early disease status (AML or refractory anemia with excess blasts (RAEB type 2) in first remission after chemotherapy or untreated RAEB type 1). Based only on age, all consecutive patients were offered one of two specific transplant protocols. Patients p50 years old received conventional high-dose conditioning with cyclophosphamide-TBI and use of CD34 þ -selected PBSCT (CTCD34 þ group), while patients aged 450 years received a reduced-intensity conditioning (RIC) with fludarabine and oral busulphan (FB-RIC). Seventy-five patients entered the study (35 in the CTCD34 þ and 39 in the FB-RIC group). The median follow-up was 44 years in both groups. The 4-year nonrelapse mortality (NRM) was 19 and 20%, respectively (P ¼ 0.8). Relapse and survival were also equivalent in both groups. These results suggest that in this setting, the expected high NRM in elderly patients can be reduced with an RIC regimen.

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Hematopoietic cell transplantation in first complete remission versus early relapse

Cited by 24 publications

References 11 publications

Comparison of matched unrelated and matched related donor myeloablative hematopoietic cell transplantation for adults with acute myeloid leukemia in first remission

Comparison of matched unrelated and matched related donor myeloablative hematopoietic cell transplantation for adults with acute myeloid leukemia in first remission

Frequency of Allogeneic Hematopoietic Cell Transplantation Among Patients With High- or Intermediate-Risk Acute Myeloid Leukemia in First Complete Remission

Comparable non-relapse mortality and survival after HLA-identical sibling blood stem cell transplantation with reduced or conventional-intensity preparative regimens for high-risk myelodysplasia or acute myeloid leukemia in first remission

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