| Literature DB >> 34428556 |
Leland Metheny1, Natalie S Callander2, Aric C Hall3, Mei-Jei Zhang4, Khalid Bo-Subait5, Hai-Lin Wang5, Vaibhav Agrawal6, A Samer Al-Homsi7, Amer Assal8, Ulrike Bacher9, Amer Beitinjaneh10, Nelli Bejanyan11, Vijaya Raj Bhatt12, Chris Bredeson13, Michael Byrne14, Mitchell Cairo15, Jan Cerny16, Zachariah DeFilipp17, Miguel Angel Diaz Perez18, César O Freytes19, Siddhartha Ganguly20, Michael R Grunwald21, Shahrukh Hashmi22, Gerhard C Hildebrandt23, Yoshihiro Inamoto24, Christopher G Kanakry25, Mohamed A Kharfan-Dabaja26, Hillard M Lazarus27, Jong Wook Lee28, Sunita Nathan29, Taiga Nishihori30, Richard F Olsson31, Olov Ringdén32, David Rizzieri33, Bipin N Savani34, Mary Lynn Savoie35, Sachiko Seo36, Marjolein van der Poel37, Leo F Verdonck38, John L Wagner39, Jean A Yared40, Christopher S Hourigan41, Partow Kebriaei42, Mark Litzow43, Brenda M Sandmaier44, Wael Saber5, Daniel Weisdorf45, Marcos de Lima46.
Abstract
Patients who develop therapy-related myeloid neoplasm, either myelodysplastic syndrome (t-MDS) or acute myelogenous leukemia (t-AML), have a poor prognosis. An earlier Center for International Blood and Marrow Transplant Research (CIBMTR) analysis of 868 allogeneic hematopoietic cell transplantations (allo-HCTs) performed between 1990 and 2004 showed a 5-year overall survival (OS) and disease-free survival (DFS) of 22% and 21%, respectively. Modern supportive care, graft-versus-host disease prophylaxis, and reduced-intensity conditioning (RIC) regimens have led to improved outcomes. Therefore, the CIBMTR analyzed 1531 allo-HCTs performed in adults with t-MDS (n = 759) or t-AML (n = 772) between and 2000 and 2014. The median age was 59 years (range, 18 to 74 years) for the patients with t-MDS and 52 years (range, 18 to 77 years) for those with t-AML. Twenty-four percent of patients with t-MDS and 11% of those with t-AML had undergone a previous autologous (auto-) HCT. A myeloablative conditioning (MAC) regimen was used in 49% of patients with t-MDS and 61% of patients with t-AML. Nonrelapse mortality at 5 years was 34% (95% confidence interval [CI], 30% to 37%) for patients with t-MDS and 34% (95% CI, 30% to 37%) for those with t-AML. Relapse rates at 5 years in the 2 groups were 46% (95% CI, 43% to 50%) and 43% (95% CI, 40% to 47%). Five-year OS and DFS were 27% (95% CI, 23% to 31%) and 19% (95% CI, 16% to 23%), respectively, for patients with t-MDS and 25% (95% CI, 22% to 28%) and 23% (95% CI, 20% to 26%), respectively, for those with t-AML. In multivariate analysis, OS and DFS were significantly better in young patients with low-risk t-MDS and those with t-AML undergoing HCT with MAC while in first complete remission, but worse for those with previous auto-HCT, higher-risk cytogenetics or Revised International Prognostic Scoring System score, and a partially matched unrelated donor. Relapse remains the major cause of treatment failure, with little improvement seen over the past 2 decades. These data mandate caution when recommending allo-HCT in these conditions and indicate the need for more effective antineoplastic approaches before and after allo-HCT.Entities:
Keywords: Acute myelogenous leukemia; Allogeneic transplantation; Myelodysplasia
Mesh：
Year: 2021 PMID： 34428556 PMCID： PMC9064046 DOI： 10.1016/j.jtct.2021.08.010
Source DB: PubMed Journal: Transplant Cell Ther ISSN： 2666-6367