Transplant Outcomes for Secondary Acute Myeloid Leukemia: Acute Leukemia Working Party of the European Society for Blood and Bone Marrow Transplantation Study
2 CRSA - Centre de Recherche Saint-Antoine
3 MHH - Medizinische Hochschule Hannover = Hannover Medical School
4 WWU - Westfälische Wilhelms-Universität Münster = University of Münster = Université de Münster [Münster, Allemagne]
5 TU Dresden - Technische Universität Dresden = Dresden University of Technology
6 Uniklinik Essen - Universitätsklinikum Essen = University Hospital Essen [Universität Duisburg-Essen]
7 AöR - University Hospital Essen
8 Division Hematology, Oncology and Hemostasiology [Leipzig, Germany]
9 Service d’Hématologie [Institut Paoli Calmettes, Marseille]
10 CRCM - Centre de Recherche en Cancérologie de Marseille
11 Department of Medicine V
12 KCH - King's College Hospital
13 Laboratoire d'Hématologie [CHU Nantes]
14 IRSN/DRPH/SRBE/LTCRA - Laboratoire de Thérapie Cellulaire et de Radioprotection Accidentelle
15 IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer
16 IRCCS Ospedale San Raffaele [Milan, Italy]
17 ULiège - Université de Liège = University of Liège = Universiteit van Luik = Universität Lüttich
18 LMU - Ludwig Maximilian University [Munich] = Ludwig Maximilians Universität München
19 Cancer Center Gliwice
20 UPMC - Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie
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Résumé
Secondary acute myeloid leukemia (sAML) has been associated with inferior outcomes compared with de novo AML. Little is known about patient risk factors and outcomes in sAML after allogeneic hematopoietic stem cell transplantation (HCT); thus, this large systemic analysis of the European Society for Blood and Bone Marrow Transplantation registry was performed. This study included 4997 patients with sAML who received HCT from 2000 to 2016. In univariate analysis the 2-year cumulative incidence of chronic graft-versus-host disease (GVHD), relapse, and nonrelapse mortality (NRM) were 33.5% (95% confidence interval [Cl], 32% to 34.9%), 33.7% (95% CI, 32.3% to 35.1%), and 27.5% (95% CI, 26.1% to 28.7%), respectively. Overall survival (OS), leukemia-free survival (LFS), and GVHD-free, relapse-free survival (GRFS) at 2 years were 44.5% (95% CI, 43% to 46%), 38.8% (95% CI, 37.4% to 40.3%), and 27.2% (95% Cl, 25.9% to 28.6%), respectively. In multivariate analysis, patients receiving myeloablative regimens had decreased relapse (hazard ratio, .859; 95% CI, .761 to .97; P = .01), higher NRM (hazard ratio, 1.175; 95% CI, 1.03 to 1341; P = .02), and no differences in OS, LFS, and GRFS compared with patients receiving reduced-intensity conditioning regimens. Active disease, adverse cytogenetics, older age, Karnofsky performance status (<= 80%), ex vivo T cell depletion, other malignant hematologic diseases, and patient cytomegalovirus seropositivity were associated with inferior OS and LFS. These variables should be considered in patients with sAML in need of HCT, and further study regarding the impact of conditioning regimens on relapse is needed. (C) 2018 American Society for Blood and Marrow Transplantation.
