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Allografting

Improved outcome in young adults with de novo acute myeloid leukemia in first remission, undergoing an allogeneic bone marrow transplant

Bone Marrow Transplantation volume 40, pages 349–354 (2007)Cite this article

Abstract

We assessed the outcome of 170 patients with AML in first complete remission, aged 1–47 years (median 29), who had undergone an allogeneic BMT before or after 1990 (n=80 and n=90, respectively); all patients were prepared with cyclophosphamide and TBI; the median follow-up for surviving patients was 13 years. The donor was an HLA-identical sibling in 164 patients. Transplant-related mortality (TRM) was 30% before and 7% after 1990 (P<0.001); relapse-related death (RRD) was 26 and 11% (P=0.002); and actuarial 10-year survival was 42 and 79% (P<0.00001). Patients transplanted after 1990 were older, had a shorter interval diagnosis-BMT, had less FAB-M3 cases, received a higher dose of TBI, a higher marrow cell dose and combined (cyclosporine+methotrexate) GVHD prophylaxis. Patients relapsing after transplant had an actuarial survival of 0 vs 31% if grafted before or after 1990 (P=0.01), and their median follow-up exceeds 10 years. In conclusion, the overall survival of first remission AML undergoing an allogeneic BMT has almost doubled in the past two decades, despite older age and fewer M3 cases. Improvement has come not only from changes in transplant procedures, but also from effective rescue of patients relapsing after transplant.

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References

  1. Zittoun RA, Mandelli F, Willemze R, de Witte T, Labar B, Resegotti L et al. Autologous or allogeneic bone marrow transplantation compared with intensive chemotherapy in acute myelogenous leukemia. European organization for research and treatment of cancer (EORTC) and the gruppo italiano malattie ematologiche maligne dell’adulto (GIMEMA) leukemia cooperative groups. N Engl J Med 1995; 332: 217–223.

    Article  CAS  PubMed  Google Scholar 

  2. Cassileth PA, Harrington DP, Appelbaum FR, Lazarus HM, Rowe JM, Paietta E et al. Chemotherapy compared with autologous or allogeneic bone marrow transplantation in the management of acute myeloid leukemia in first remission. N Engl J Med 1998; 339: 1649–1656.

    Article  CAS  PubMed  Google Scholar 

  3. Harousseau JL, Cahn JY, Pignon B, Witz F, Milpied N, Delain M et al. Comparison of autologous bone marrow transplantation and intensive chemotherapy as postremission therapy in adult acute myeloid leukemia. The Groupe Ouest Est Leucemies Aigues Myeloblastiques (GOELAM). Blood 1997; 90: 2978–2986.

    CAS  PubMed  Google Scholar 

  4. Entz-Werle N, Suciu S, van der Werff ten Bosch J, Vilmer E, Bertrand Y, Benoit Y et al. Results of 58872 and 58921 trials in acute myeloblastic leukemia and relative value of chemotherapy vs allogeneic bone marrow transplantation in first complete remission: the EORTC Children Leukemia Group report. Leukemia 2005; 19: 2072–2081.

    Article  CAS  PubMed  Google Scholar 

  5. Burnett AK, Wheatley K, Goldstone AH, Stevens RF, Hann IM, Rees JHK et al. The value of allogeneic bone marrow transplant in patients with acute myeloid leukemia at differing risk of relapse: results of the UK AML 10 trial. Br J Haemat 2002; 118: 385–400.

    Article  Google Scholar 

  6. Bleakley M, Lau L, Shaw PJ, Kaufman A . Bone marrow transplantation for pediatric AML in first remission: a systematic review and meta-analysis. Bone Marrow Transplant 2002; 29: 843–852.

    Article  CAS  PubMed  Google Scholar 

  7. Suciu S, Mandelli F, de Witte F, Zittoun R, Gallo E, Labar B et al. Allogeneic compared with autologous stem cell transplantation in the treatment of patients younger than 46 years with acute myeloid leukemia (AML) in first complete remission (CR1): an intention-to-treat analysis of the EORTC/GIMEMA AML-10 trial. Blood 2003; 102: 1232–1240.

    Article  CAS  PubMed  Google Scholar 

  8. Yanada M, Matsuo K, Emi N, Naoe T . Efficacy of allogeneic hematopoietic stem cell transplantation depends on cytogenetic risk for acute myeloid leukemia in first disease remission: a metaanalysis. Cancer 2005; 103: 1652–1658.

    Article  PubMed  Google Scholar 

  9. Tallman MS, Kopecky KJ, Amos D, Dahlberg S, Hewlett JS, Files JC et al. Analysis of prognostic factors for the outcome of marrow transplantation or further chemotherapy for patients with acute nonlymphocytic leukemia in first remission. J Clin Oncol 1989; 7: 326–337.

    Article  CAS  PubMed  Google Scholar 

  10. Kim DH, Sohn SK, Kim JG, Lee NY, Sung WJ, Baek JH et al. Parameters for predicting allogeneic PBSCT outcome of acute myeloid leukemia: cytogenetics at presentation versus disease status at transplantation. Ann Hematol 2005; 84: 25–32.

    Article  PubMed  Google Scholar 

  11. Gale RP, Horowitz MM, Weiner RS, Ash RC, Atkinson K, Babu R et al. Impact of cytogenetics abnormalities on outcome of bone marrow transplants in acute myeloid leukemia in first remission. Bone Marrow Transplant 1995; 16: 203–208.

    CAS  PubMed  Google Scholar 

  12. Grimwade D, Walker H, Oliver F, Wheatley K, Harrison C, Harrison G et al. The importance of diagnostic cytogenetics on outcome in AML: analysis of 1612 patients entered into the MRC AML 10 trial. The Medical Research Council Adult and Children's Leukemia Working Parties. Blood 1998; 92: 2322–2333.

    CAS  PubMed  Google Scholar 

  13. Ferrant A, Labopin M, Frassoni F, Prentice HG, Cahn JY, Blaise D et al. Karyotype in acute myeloblastic leukemia: prognostic significance for bone marrow transplantation in first remission: a European Group for Blood and Marrow Transplantation study. Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT). Blood 1997; 90: 2931–2938.

    CAS  PubMed  Google Scholar 

  14. Aoudjhane M, Labopin M, Gorin NC, Shimoni A, Ruutu T, Kolb HJ et al. Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic haematopoietic stem cell transplantation for patients older than 50 years of age with acute myeloblastic leukemia: a retrospective survey from the Acute Leukemia Working Party (ALWP) of the European group for Blood and Marrow Transplantation (EBMT). Leucemia 2005; 19: 2304–2312.

    CAS  Google Scholar 

  15. Clift RA, Buckner CD, Appelbaum FR, Bearman SL, Peterson FB, Fisher LD et al. Allogeneic marrow transplantation in patients with acute myeloid leukemia in first remission: a randomized trial of two irradiation regimens. Blood 1990; 76: 1867–1871.

    CAS  PubMed  Google Scholar 

  16. Frassoni F, Labopin M, Powles R, Mary JY, Arcese W, Bacigalupo A et al. Effect of center on outcome of bone marrow transplantation for acute myeloid leukemia. Lancet 2000; 355: 1393–1398.

    Article  CAS  PubMed  Google Scholar 

  17. Loberiza FR, Zhang MJ, Lee SJ, Klein JP, LeMaistre CF, Serna DS et al. Association of transplant center and physician factors on mortality after hematopoietic stem cell transplantation in the United States. Blood 2005; 105: 2979–2987.

    Article  CAS  PubMed  Google Scholar 

  18. Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR et al. Proposed revised criteria for the classification of the acute myeloid leukemia: a report of the French-American-British Cooperative Group. Ann Intern Med 1985; 103: 620–625.

    Article  CAS  PubMed  Google Scholar 

  19. Frassoni F, Scarpati D, Bacigalupo A, Vitale V, Corvo R, Miceli S et al. The effect of total body irradiation dose and chronic graft-versus-host disease on leukemic relapse after allogeneic bone marrow transplantation. Br J Hematol 1989; 73: 211–216.

    Article  CAS  Google Scholar 

  20. Glucksberg H, Storb R, Fefer A, Buckner CD, Neiman PE, Clift RA et al. Clinical manifestations of acute graft-versus-host disease in human recipients of marrow from HLA-matched sibling donors. Transplantation 1974; 18: 295–304.

    Article  CAS  PubMed  Google Scholar 

  21. Lee SJ, Vogelsang G, Flowers ME . Chronic graft versus host disease. Biol Blood Marrow Transplant 2003; 9: 215–233.

    Article  CAS  PubMed  Google Scholar 

  22. Gorin NC, Aegerter P, Auvert B, Meloni G, Goldstone AH, Burnett AK et al. Autologous bone marrow transplantation for acute myelocytic leukemia in first remission: a European survey of the role of marrow purging. J Clin Oncol 1991; 9: 1840–1847.

    Article  Google Scholar 

  23. Bacigalupo A, Tong J, Podest M, Piaggio G, Figari O, Colombo P et al. Bone marrow harvest for marrow transplantation: effect of multiple small (2 ml) or large (20 ml) aspirates. Bone Marrow Transplant 1992; 9: 467–470.

    CAS  PubMed  Google Scholar 

  24. Gorin NC, Labopin M, Rocha V, Arcese W, Beksac M, Gluckman E et al. Marrow versus peripheral blood for geno-identical allogeneic stem cell transplantation in acute myelocytic leukemia: influence of dose and stem cell source shows better outcome with rich marrow. Blood 2003; 102: 3043–3051.

    Article  CAS  PubMed  Google Scholar 

  25. Gratwohl A, Brand R, Frassoni F, Rocha V, Niederwieser D, Reusser P et al. Cause of death after allogeneic haematopoietic stem cell transplantation (HSCT) in early leukaemias: an EBMT analysis of lethal infectious complications and changes over calendar time. Bone Marrow Transplant 2005; 36: 757–769.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Dipartimento di Emato-Oncologia, Ospedale San Martino, Genova, Italy

    D Vicente, T Lamparelli, F Gualandi, D Occhini, A M Raiola, A Ibatici, M T Van Lint, M Gobbi, M Miglino, M Clavio, M Risso, F Frassoni & A Bacigalupo

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  1. D Vicente
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  2. T Lamparelli
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Correspondence to A Bacigalupo.

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Vicente, D., Lamparelli, T., Gualandi, F. et al. Improved outcome in young adults with de novo acute myeloid leukemia in first remission, undergoing an allogeneic bone marrow transplant. Bone Marrow Transplant 40, 349–354 (2007). https://doi.org/10.1038/sj.bmt.1705739

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