Outcome of high-risk acute myeloid leukemia after allogeneic hematopoietic cell transplantation: negative impact of abnl(17p) and −5/5q−

Abstract

The European LeukemiaNet classification combines a heterogeneous group of aberrations as adverse-risk abnormalities. Our goal was to investigate the outcomes associated with distinct high-risk chromosomal abnormalities in acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (HSCT). We performed a retrospective cohort analysis in patients with high-risk AML who received first, HLA-compatible, allogeneic HSCT between January 2005 and December 2008. Data from 236 patients with a median age of 55 years were included. Because complex karyotype (CK), ؊5/5q؊, and abnl(17p) are overlapping categories, a hierarchical classification system based on the presence or absence of abnl(17p) and ؊5/5q؊ was developed. Patients with abnl(17p) had a 2-year event-free survival (EFS) of 11% (95% confidence interval [CI], 0%-25%), patients with ؊5/5q؊ but no abnl(17p) a 2-year EFS of 29% (95% CI, 14%-44%), and patients with adverse-risk AML but neither of the 2 marker lesions a 2-year EFS of 49% (95% CI, 39%-59%). Notably, complex and monosomal karyotypes lost their prognostic value when these marker lesions were excluded. In conclusion, hierarchical classification of adverse-risk karyotypes by 2 marker lesions, abnl(17p) and ؊5/5q؊, is effective in prognostication of the outcome of alloge-

Outcome of conditioning intensity in acute myeloid leukemia with monosomal karyotype in patients over 45 year‐old: A study from the acute leukemia working party (ALWP) of the European group of blood and marrow transplantation (EBMT)

“…Allogeneic SCT appears as the preferred therapeutic option, with long-term OS achievable in 20 2 30% [9,11,22]. Our large cohort of 303 MK AML patients transplanted in CR1 confirms those results, with a 3-year probability of OS of 34%.…”

“…Hypodiploidy is usually associated with MK and was, indeed, the main group of our study. The worse outcomes associated with hypodiploidy may not come from hypodiploidy by itself but from other bad-risk cytogenetics such as 5q-or abnl(17p) [22]. Nevertheless, hypodiplo€ ıdy in our study was significantly associated with worse outcomes even in patients without 25/5q-or without abnl(17p).…”

Specific abnormalities versus number of abnormalities and cytogenetic scoring systems for outcome prediction after allogeneic hematopoietic SCT for myelodysplastic syndromes

“…In line with our findings, recent studies have questioned the relative importance of MK in MDS and secondary AML (sAML) as compared with burden of cytogenetic complexity. [18][19][20][21][22][23] IPSS-R cytogenetic classification predicted OS more efficiently than IPSS cytogenetic classification, a finding consistent with those of a larger series of MDS/sAML patients who underwent HCT 10 ( Table 6), suggesting that IPSS-R cytogenetic classification may indeed refine prognosis not only in untreated patients but also after HCT. In addition, IPSS-R cytogenetic classification as a five-group score, but not MK, was predictive of increased CIR, possibly as a result of the additional impact of 3q21q26 and del 7q found within non-MK (60% in each case).…”

Emerging strategies for high-risk and relapsed/refractory acute myeloid leukemia: Novel agents and approaches currently in clinical trials

“…Given that, physiological age is probably more important than chronological age. Moreover, certain patients initially considered favorable-or intermediate-risk might later declare themselves as high-risk if they have AML refractory to two cycles of induction therapy, a short duration of remission, or relapse following an allogeneic hematopoietic cell transplant (HCT) [1][2][3][4][5][6][7].…”