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Outcome of allografting for AML-CR2 is equivalent across BSBMT and EBMT and is associated with encouraging OS and DFS across all age groups

Bone Marrow Transplantation volume 54, pages 1151–1154 (2019)Cite this article

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Allogeneic haematopoietic stem cell transplantation is the most effective anti-leukaemic therapy for acute myeloid leukaemia (AML). However, due to the significant risks of transplant-related mortality (TRM) from infection, regimen-related toxicities and graft versus host disease (GVHD), not all patients receive transplants in Complete remission 1 (CR1). Currently, this decision depends on risk stratification, balancing the risks of relapse versus TRM. In general, allogeneic transplantation is reserved for intermediate- or poor-risk patients in CR1, but not for good-risk patients who have a lower chance of relapse and a high chance of salvage [1, 2]. Following relapse, AML has a poor outlook [3]. The only curative approach is with an allogeneic transplant following re-induction chemotherapy, in which superior outcomes have been confirmed as compared to those not transplanted [4, 5]. It is often perceived that allografts for AML-CR2 have inferior outcomes as compared to CR1 transplants, but there is limited published data for those allografted in CR2 since most studies report data for CR1 and CR2 patients combined.

We analysed the outcomes of 534 UK and 3070 AML-CR2 patients reported to the European Group for Blood and Marrow Transplantation (EBMT), from 2006 to 2011. There was a 50% increase in the number of AML-CR2 allografts performed during this time period in both the British Society for Blood and Marrow Transplantation (BSBMT) (70–104) and EBMT (420–623) cohorts. Reduced-intensity conditioning (RIC) regimens exceeded myeloablative regimens, accounting for 55 and 66% of transplants done by the BSBMT and the whole cohort. Furthermore, 19% of the UK allografts for AML-CR2 and 16% of the EBMT cases were in patients aged > 60 years. The proportion of paediatric cases was similar (14 and 15%) in the two cohorts. More than 60–75% of the allografts were performed using an unrelated donor, and the source of stem cells was peripheral blood stem cells in > 70% of cases, with 10% or fewer being from cord blood. Although the length of CR1 was largely unknown, the median time from AML diagnosis to transplant was 18–19 months in both groups, suggesting an average CR1 duration of 6–12 months.

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Authors and Affiliations

  1. Nottingham University Hospitals Trust, Nottingham, UK

    Jenny Byrne

  2. British Society for Blood and Marrow Transplantation, Guys and St Thomas Hospital, London, UK

    Jenny Byrne, Rachel Pearce, Julia Perry, C. Crawley & Graham Jackson

  3. Addenbrookes Hospital Trust, Cambridge, UK

    C. Crawley

  4. Newcastle Royal Infirmary Trust, Newcastle, UK

    Graham Jackson

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  1. Jenny Byrne
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  2. Rachel Pearce
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Correspondence to Jenny Byrne.

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Byrne, J., Pearce, R., Perry, J. et al. Outcome of allografting for AML-CR2 is equivalent across BSBMT and EBMT and is associated with encouraging OS and DFS across all age groups. Bone Marrow Transplant 54, 1151–1154 (2019). https://doi.org/10.1038/s41409-019-0439-y

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