Fotios V Michelis1, Vikas Gupta1, Mei-Jie Zhang2,3, Hai-Lin Wang2, Mahmoud Aljurf4, Ulrike Bacher5,6, Amer Beitinjaneh7, Yi-Bin Chen8, Zachariah DeFilipp9, Robert Peter Gale10, Partow Kebriaei11, Mohamed Kharfan-Dabaja12, Hillard M Lazarus13, Taiga Nishihori12, Richard F Olsson14,15, Betul Oran11, Armin Rashidi16, David A Rizzieri17, Martin S Tallman18, Marcos de Lima13, H Jean Khoury9, Brenda M Sandmaier19,20, Daniel Weisdorf21, Wael Saber2. 1. Allogeneic Blood and Marrow Transplant Program, Princes Margaret Cancer Centre, Toronto, Ontario, Canada. 2. Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. 3. Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin. 4. Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia. 5. Department of Hematology/Oncology, University Medicine Gottingen, Gottingen, Germany. 6. Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany. 7. University of Miami, Miami, Florida. 8. Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts. 9. Emory University Hospital, Atlanta, Georgia. 10. Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom. 11. Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas. 12. Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. 13. Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio. 14. Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. 15. Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden. 16. Division of Oncology, Washington University School of Medicine, St. Louis, Missouri. 17. Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina. 18. Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. 19. Division of Medical Oncology, University of Washington, Seattle, Washington. 20. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. 21. Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
Abstract
BACKGROUND: Allogeneic hematopoietic cell transplantation (HCT) offers curative potential to a number of older patients with acute myeloid leukemia (AML) in their first complete remission. However, there are limited data in the literature concerning post-HCT outcomes for older patients in their second complete remission (CR2). METHODS: The purpose of the current study was to retrospectively investigate within the Center for International Blood and Marrow Transplant Research database parameters influencing posttransplant outcomes for patients 60 years of age or older undergoing HCT for AML in CR2. RESULTS: In total, 196 patients from 78 centers were identified; the median age was 64 years (range, 60-78 years). Seventy-one percent had a Karnofsky performance status ≥ 90 at the time of HCT. Reduced-intensity conditioning regimens were used in 159 patients (81%). A univariate analysis demonstrated a 3-year overall survival (OS) rate of 42% (95% confidence interval [CI], 35%-49%), a leukemia-free survival rate of 37% (95% CI, 30%-44%), a cumulative incidence of nonrelapse mortality of 25% (95% CI, 19%-32%), and a cumulative incidence of relapse (CIR) of 38% (95% CI, 31%-45%). A multivariate analysis demonstrated that cytogenetic risk was the only independent risk factor for OS (P = .023) with a hazard ratio (HR) of 1.14 (95% CI, 0.59-2.19) for intermediate-risk cytogenetics and an HR of 2.32 (95% CI, 1.05-5.14) for unfavorable-risk cytogenetics. For CIR, cytogenetic risk was also the only independent prognostic factor (P = .01) with an HR of 1.10 (95% CI, 0.47-2.56) for intermediate-risk cytogenetics and an HR of 2.98 (95% CI, 1.11-8.00) for unfavorable-risk cytogenetics. CONCLUSIONS: Allogeneic HCT is a curative treatment option for older patients with AML in CR2, particularly for those with favorable or intermediate cytogenetic risk. Cancer 2017;123:2035-2042.
BACKGROUND: Allogeneic hematopoietic cell transplantation (HCT) offers curative potential to a number of older patients with acute myeloid leukemia (AML) in their first complete remission. However, there are limited data in the literature concerning post-HCT outcomes for older patients in their second complete remission (CR2). METHODS: The purpose of the current study was to retrospectively investigate within the Center for International Blood and Marrow Transplant Research database parameters influencing posttransplant outcomes for patients 60 years of age or older undergoing HCT for AML in CR2. RESULTS: In total, 196 patients from 78 centers were identified; the median age was 64 years (range, 60-78 years). Seventy-one percent had a Karnofsky performance status ≥ 90 at the time of HCT. Reduced-intensity conditioning regimens were used in 159 patients (81%). A univariate analysis demonstrated a 3-year overall survival (OS) rate of 42% (95% confidence interval [CI], 35%-49%), a leukemia-free survival rate of 37% (95% CI, 30%-44%), a cumulative incidence of nonrelapse mortality of 25% (95% CI, 19%-32%), and a cumulative incidence of relapse (CIR) of 38% (95% CI, 31%-45%). A multivariate analysis demonstrated that cytogenetic risk was the only independent risk factor for OS (P = .023) with a hazard ratio (HR) of 1.14 (95% CI, 0.59-2.19) for intermediate-risk cytogenetics and an HR of 2.32 (95% CI, 1.05-5.14) for unfavorable-risk cytogenetics. For CIR, cytogenetic risk was also the only independent prognostic factor (P = .01) with an HR of 1.10 (95% CI, 0.47-2.56) for intermediate-risk cytogenetics and an HR of 2.98 (95% CI, 1.11-8.00) for unfavorable-risk cytogenetics. CONCLUSIONS: Allogeneic HCT is a curative treatment option for older patients with AML in CR2, particularly for those with favorable or intermediate cytogenetic risk. Cancer 2017;123:2035-2042.
Keywords:
Center for International Blood and Marrow Transplant Research (CIBMTR); acute myeloid leukemia (AML); allogeneic transplant; elderly; second complete remission
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