Phase II Study of Allogeneic Transplantation for Older Patients With Acute Myeloid Leukemia in First Complete Remission Using a Reduced-Intensity Conditioning Regimen: Results From Cancer and Leukemia Group B 100103 (Alliance for Clinical Trials in Oncology)/Blood and Marrow Transplant Clinical Trial Network 0502

Devine, Steven M.; Owzar, Kouros; Blum, William; Mulkey, Flora; Stone, Richard; Hsu, Jack W.; Champlin, Richard E.; Chen, Yi Bin; Vij, Ravi; Slack, James L.; Soiffer, Robert J.; Larson, Richard A.; Shea, Thomas C.; Hárs, Vera; Sibley, Alexander B.; Giralt, Sergío; Carter, Shelly; Horowitz, Mary M.; Linker, Charles; Alyea, Edwin P.

doi:10.1200/jco.2015.62.7273

Cited by 150 publications

(101 citation statements)

References 37 publications

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“…104 A prospective multicenter phase II study examined the efficacy of RIC allogeneic HCT in older patients (range, 60-74 years) with AML in first CR (n=114). 105 After allogeneic HCT, DFS and OS at 2 years were 42% (95% CI, 33%-52%) and 48% (95% CI, 39%-58%), respectively, for the entire group. 105 A time-dependent analysis of 4 successive prospective HOVON/SAKK AML trials examined data from patients aged ≥60 years who experienced a first CR after induction chemotherapy (n=640).…”

Section: Postremission Therapymentioning

confidence: 99%

“…105 After allogeneic HCT, DFS and OS at 2 years were 42% (95% CI, 33%-52%) and 48% (95% CI, 39%-58%), respectively, for the entire group. 105 A time-dependent analysis of 4 successive prospective HOVON/SAKK AML trials examined data from patients aged ≥60 years who experienced a first CR after induction chemotherapy (n=640). 106 For patients who received allogeneic HCT as postremission therapy (n=97), the 5-year OS rate was 35% (95% CI, 25%-44%).…”

Section: Postremission Therapymentioning

confidence: 99%

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Acute Myeloid Leukemia, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology

O’Donnell

Tallman

Abboud

et al. 2017

J Natl Compr Canc Netw

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475

268

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Acute myeloid leukemia (AML) is the most common form of acute leukemia among adults and accounts for the largest number of annual deaths due to leukemias in the United States. This portion of the NCCN Guidelines for AML focuses on management and provides recommendations on the workup, diagnostic evaluation, and treatment options for younger (age <60 years) and older (age ≥60 years) adult patients. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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Section: Postremission Therapymentioning

confidence: 99%

Section: Postremission Therapymentioning

confidence: 99%

Acute Myeloid Leukemia, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology

O’Donnell

Tallman

Abboud

et al. 2017

J Natl Compr Canc Netw

Self Cite

475

268

View full text Add to dashboard Cite

show abstract

“…[22][23][24] Similarly, a prospective phase 2 study by Cancer and Leukemia Group B showed that patients with a median age of 65 years had leukemia-free survival (LFS) and OS after 2 years of 42%, and that HCT was overall well tolerated, with superior outcomes when compared with nontransplant treatment. 25 Although outcomes of patients with all subtypes of AML after MAC and RIC are well described, the outcomes of patients who are specifically transplanted with sAML are not. Thus, this study by the Acute Leukemia Working Party (ALWP) of the European Society for Blood and Marrow Transplant (EBMT) network was undertaken.…”

Section: Introductionmentioning

confidence: 99%

Conditioning intensity in secondary AML with prior myelodysplastic syndrome/myeloproliferative disorders: an EBMT ALWP study

et al. 2018

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Key Points• Allogeneic HCT can result in long-term survival for patients with sAML and prior MDS/MPN.• Myeloablative conditioning regimens should be selected for sAML and patients with prior MDS/MPN whenever possible.Patients with secondary AML (sAML) with antecedent myelodysplastic syndrome (MDS) or myeloproliferative neoplasms (MPNs) tend to have high-risk disease based on the older age of patients, high-risk cytogenetics, and higher number of prior treatments. was given to 40% of patients, and 60% received reduced-intensity conditioning (RIC).Overall, the 2-year cumulative incidence of relapse (RI) was 37%, leukemia-free survival (LFS) was 40%, overall survival (OS) was 46%, nonrelapse mortality (NRM) was 23%, and chronic graft-versus-host disease (cGVHD) was 39%. In univariate analysis, a statistical difference between conditioning regimens 6 months after HCT in favor of the MAC group was noted with regard to RI (hazard ratio [HR], 1.47; P 5 .03), LFS (HR, 1.43; P 5 .01), and OS (HR, 1.55; P , .05). There was no difference in the cumulative incidence of NRM (HR, 1.38; P 5 .15). This effect was similarly seen in multivariate analysis (MVA):cumulative incidence of relapse (HR, 1.79; P , .05), LFS (HR, 1.43; P 5 .02), and OS (HR, 1.53; P 5 .005) with no difference in NRM (HR, 1; P 5 .98). This EBMT ALWP analysis suggests that long-term survival can be achieved in patients with sAML with antecedent MDS/MPN and that MAC is a suitable conditioning regimen in patients with sAML.

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“…A multi-institutional trial of reduced intensity fludarabine and busulfan described encouraging low rates of 2-year NRM of 15% and 2-year survival of 48% for AML in first remission. 14 Sorror et al reported favorable 5-year OS of 35% after nonmyeloablative allogeneic for prospectively enrolled patients $60 years.…”

Section: Older Age and Transplant Utilizationmentioning

confidence: 99%

Biologic vs physiologic age in the transplant candidate

Artz

2016

Hematology

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Hematopoietic cell transplantation (HCT) remains a cornerstone of treatment of many hematologic malignancies but transplant-associated morbidity and mortality limit application to older patients. Biologic or chronologic age barriers to HCT have fallen, because patients in their 8th decade of life comprise the group with the greatest rise in transplant use over the past decade. Evaluating physiologic age or general health in older transplant candidates requires a systematic approach inclusive of functional and comorbidity assessment, which typically is accomplished through geriatric assessment (GA). GA incorporates measures of comorbidity, function, nutrition, social support, and other health-related domains to better describe physiologic age. Older allogeneic transplant patients have a surprisingly high prevalence of vulnerabilities by GA prior to transplant, and significant comorbidity or functional limitations heighten the risks of transplant-related mortality. Ultimately, incorporation of physiologic age can improve estimates of nondisease life expectancy, prognostic survival after HCT, and inform HCT candidacy. Future research on the optimal tools to characterize physiologic age and appropriate interventions in the context of transplant are needed.

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Cited by 150 publications

References 37 publications

Acute Myeloid Leukemia, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology

Acute Myeloid Leukemia, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology

Conditioning intensity in secondary AML with prior myelodysplastic syndrome/myeloproliferative disorders: an EBMT ALWP study

Biologic vs physiologic age in the transplant candidate

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