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Acute leukemia

Factors predicting outcome after allogeneic transplant in refractory acute myeloid leukemia: a retrospective analysis of Gruppo Italiano Trapianto di Midollo Osseo (GITMO)

Bone Marrow Transplantation volume 52, pages 955–961 (2017)Cite this article

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Abstract

The clinical outcome of primary refractory (PRF) AML patients is poor and only a minor proportion of patients is rescued by allogenic hematopoietic stem cell transplantation (HSCT). The identification of pre-HSCT variables may help to determine PRF AML patients who can most likely benefit from HSCT. We analyzed PRF AML patients transplanted between 1999 and 2012 from a sibling, unrelated donor or a cord blood unit. Overall, 227 patients from 26 Gruppo Italiano Trapianto di Midollo Osseo e Terapia cellulare centers were included in the analysis. At 3 years, the overall survival was 14%. By multivariate analysis, the number of chemotherapy cycles, (hazard ratio (HR): 1.87; 95% confidence interval (CI): 1.24–2.85; P=0.0028), the percentage of bone marrow or peripheral blood blasts (HR: 1.75; 95% CI: 1.16–2.64; P=0.0078), the adverse cytogenetic (HR: 1.44; 95% CI: 1.00–2.07; P=0.0508) and the age of patients (HR: 1.77; 95% CI: 1.08–2.88; P=0.0223) remained significantly associated with survival. Thus, we set up a new score predicting at 3 years after transplantation, an overall survival probability of 32% for patients with score 0 (no or 1 prognostic factor), 10% for patients with score 1 (2 prognostic factors) and 3% for patients with score 2 (3 or 4 prognostic factors).

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Acknowledgements

We thank all GITMO centers for their remarkable contribution in patients’ care and assistance to their families, and for their attention and dedication in sending patients data (see Supplementary Appendix 1).

Author information

Author notes

  1. E Todisco, C Boschini and A Rambaldi: These authors contributed equally to this work.

  2. University of Milan, Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy

Authors and Affiliations

  1. Department of Hematology and Oncology, Humanitas Cancer Center, Rozzano-Milano, Italy

    E Todisco, L Castagna & A Santoro

  2. Hematology and BMT Unit, San Raffaele Scientific Institute, Milano, Italy

    F Ciceri & F Giglio

  3. Hematology and BMT Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy

    C Boschini, E Oldani & A Rambaldi

  4. Hematology and BMT Unit, Catholic University, Policlinico A. Gemelli, Rome, Italy

    A Bacigalupo & P Chiusolo

  5. Hematology and BMT Unit, Azienda Ospedaliera Universitaria Ospedale Santa Maria della Misericordia, Udine, Italy

    F Patriarca

  6. Department of Hematology, BMT Unit, Univeristy of Firenze, Firenze, Italy

    I Donnini & A Bosi

  7. Department of Hematology Oncology, IRCCS Fondazione Policlinico San Matteo & University of Pavia, Pavia, Italy

    E P Alessandrino

  8. Hematology and Stem Cell Transplant Unit, Policlinico Tor Vergata, Rome, Italy

    W Arcese

  9. Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy

    A P Iori

  10. Department of Hematology Oncology, Ospedale Niguarda Ca' Granda, Milano, Italy

    P Marenco

  11. Hematology and BMT Unit, Ospedale Generale Regionale di Bolzano, Bolzano, Italy

    I Cavattoni

  12. Department of Clinical Medicine and Prevention, University of Milano Bicocca, Monza, Italy

    E Terruzzi

  13. GITMO Data Center, IRCCS AOU San Martino, Genova, Italy

    B Bruno

  14. Bologna University, S. Orsola-Malpighi Hospital-Institute of Hematology & Medical Oncology L & A Seràgnoli, Bologna, Italy

    F Bonifazi

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  1. E Todisco
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  2. F Ciceri
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  3. C Boschini
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  18. E Oldani
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Correspondence to A Rambaldi.

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The authors declare no conflict of interest.

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Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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Todisco, E., Ciceri, F., Boschini, C. et al. Factors predicting outcome after allogeneic transplant in refractory acute myeloid leukemia: a retrospective analysis of Gruppo Italiano Trapianto di Midollo Osseo (GITMO). Bone Marrow Transplant 52, 955–961 (2017). https://doi.org/10.1038/bmt.2016.325

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