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Post-Transplant Complications

Duration of first remission, hematopoietic cell transplantation-specific comorbidity index and patient age predict survival of patients with AML transplanted in second CR

Bone Marrow Transplantation volume 48, pages 1450–1455 (2013)Cite this article

Abstract

Allo-SCT is potentially curative for patients with AML. Patients transplanted in CR2 tend to experience inferior survival compared with those in CR1. We retrospectively investigated the impact of pretransplant variables on the outcome of patients transplanted with AML in CR2. Ninety-four patients with AML in CR2 received a transplant between 1999 and 2011 with myeloablative (MA, n=65) or reduced-intensity conditioning regimens (RIC, n=29). Variables investigated included cytogenetic risk at diagnosis (SWOG), hematopoietic cell transplantation-specific comorbidity index (HCT-CI), CMV status, duration of CR1 and age. Median age of all patients was 47 years (range 18–70). Multivariable analysis for OS identified three prognostically significant categories: a favorable risk group included patients with duration of CR1 ⩾6 months, age <55 years and HCT-CI score 0–3, an intermediate risk group with duration of CR1 ⩾6 months, age <55 years and HCT-CI score 4–5 and a high-risk group with duration of CR1 <6 months or age ⩾55 years (P=0.0001) with 5-year survivals of 53%, 31% and 6%, respectively. Acute and chronic GVHD did not influence this risk stratification. The stated risk factors discriminate patients with different OS and may assist in decision making for allo-SCT.

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References

  1. Appelbaum FR . Allogeneic hematopoietic stem cell transplantation for acute leukemia. Semin Oncol 1997; 24: 114–123.

    CAS  PubMed  Google Scholar 

  2. Cornelissen JJ, van Putten WL, Verdonck LF, Theobald M, Jacky E, Daenen SM et al. Results of a HOVON/SAKK donor versus no-donor analysis of myeloablative HLA-identical sibling stem cell transplantation in first remission acute myeloid leukemia in young and middle-aged adults: benefits for whom? Blood 2007; 109: 3658–3666.

    Article  CAS  PubMed  Google Scholar 

  3. Koreth J, Schlenk R, Kopecky KJ, Honda S, Sierra J, Djulbegovic BJ et al. Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials. JAMA 2009; 301: 2349–2361.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Chalandon Y, Barnett MJ, Horsman DE, Conneally EA, Nantel SH, Nevill TJ et al. Influence of cytogenetic abnormalities on outcome after allogeneic bone marrow transplantation for acute myeloid leukemia in first complete remission. Biol Blood Marrow Transplant 2002; 8: 435–443.

    Article  PubMed  Google Scholar 

  5. Gooley TA, Chien JW, Pergam SA, Hingorani S, Sorror ML, Boeckh M et al. Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med 2010; 363: 2091–2101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Gyurkocza B, Storb R, Storer BE, Chauncey TR, Lange T, Shizuru JA et al. Nonmyeloablative allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia. J Clin Oncol 2010; 28: 2859–2867.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106: 2912–2919.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Hemmati PG, Terwey TH, le Coutre P, Vuong LG, Massenkeil G, Dörken B et al. A modified EBMT risk score predicts the outcome of patients with acute myeloid leukemia receiving allogeneic stem cell transplants. Eur J Haematol 2011; 86: 305–316.

    Article  PubMed  Google Scholar 

  9. Michallet M, Thomas X, Vernant JP, Kuentz M, Socié G, Espérou-Bourdeau H et al. Long-term outcome after allogeneic hematopoietic stem cell transplantation for advanced stage acute myeloblastic leukemia: a retrospective study of 379 patients reported to the Societe Francaise de Greffe de Moelle (SFGM). Bone Marrow Transplant 2000; 26: 1157–1163.

    Article  CAS  PubMed  Google Scholar 

  10. Breems DA, Van Putten WL, Huijgens PC, Ossenkoppele GJ, Verhoef GE, Verdonck LF et al. Prognostic index for adult patients with acute myeloid leukemia in first relapse. J Clin Oncol 2005; 23: 1969–1978.

    Article  PubMed  Google Scholar 

  11. Wong R, Shahjahan M, Wang X, Thall PF, De Lima M, Khouri I et al. Prognostic factors for outcomes of patients with refractory or relapsed acute myelogenous leukemia or myelodysplastic syndromes undergoing allogeneic progenitor cell transplantation. Biol Blood Marrow Transplant 2005; 11: 108–114.

    Article  PubMed  Google Scholar 

  12. Armistead PM, de Lima M, Pierce S, Qiao W, Wang X, Thall PF et al. Quantifying the survival benefit for allogeneic hematopoietic stem cell transplantation in relapsed acute myelogenous leukemia. Biol Blood Marrow Transplant 2009; 15: 1431–1438.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Krauter J, Wagner K, Stadler M, Dammann E, Zucknick M, Eder M et al. Prognostic factors in allo-SCT of elderly patients with AML. Bone Marrow Transplant 2011; 46: 545–551.

    Article  CAS  PubMed  Google Scholar 

  14. Slovak ML, Kopecky KJ, Cassileth PA, Harrington DH, Theil KS, Mohamed A et al. Karyotypic analysis predicts outcome of preremission and postremission therapy in adult acute myeloid leukemia: a Southwest Oncology Group/Eastern Cooperative Oncology Group Study. Blood 2000; 96: 4075–4083.

    CAS  PubMed  Google Scholar 

  15. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J et al. 1994 Consensus Conference on Acute GVHD Grading. Bone Marrow Transplant 1995; 15: 825–828.

    CAS  PubMed  Google Scholar 

  16. Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11: 945–956.

    Article  PubMed  Google Scholar 

  17. Pepe MS, Mori M . Kaplan-meier, marginal or conditional probability curves in summarizing competing risks failure time data? Stat Med 1993; 12: 737–751.

    Article  CAS  PubMed  Google Scholar 

  18. Fine JP, Gray RJ . A proportional hazards model for the subdistribution of a competing risk. J Am Statist Assoc 1999; 94: 496–509.

    Article  Google Scholar 

  19. Estey E, Kornblau S, Pierce S, Kantarjian H, Beran M, Keating M . A stratification system for evaluating and selecting therapies in patients with relapsed or primary refractory acute myelogenous leukemia. Blood 1996; 88: 756.

    CAS  PubMed  Google Scholar 

  20. Grigg AP, Szer J, Beresford J, Dodds A, Bradstock K, Durrant S et al. Factors affecting the outcome of allogeneic bone marrow transplantation for adult patients with refractory or relapsed acute leukaemia. Br J Haematol 1999; 107: 409–418.

    Article  CAS  PubMed  Google Scholar 

  21. Tomás F, Gómez-García de Soria V, López-Lorenzo JL, Arranz R, Figuera A, Cámara R et al. Autologous or allogeneic bone marrow transplantation for acute myeloblastic leukemia in second complete remission. Importance of duration of first complete remission in final outcome. Bone Marrow Transplant 1996; 17: 979–984.

    PubMed  Google Scholar 

  22. Ferrara F, Palmieri S, Mele G . Prognostic factors and therapeutic options for relapsed or refractory acute myeloid leukemia. Haematologica 2004; 89: 998–1008.

    CAS  PubMed  Google Scholar 

  23. Armand P, Kim HT, Zhang MJ, Perez WS, Dal Cin PS, Klumpp TR et al. Classifying cytogenetics in patients with acute myelogenous leukemia in complete remission undergoing allogeneic transplantation: a Center for International Blood and Marrow Transplant Research study. Biol Blood Marrow Transplant 2012; 18: 280–288.

    Article  PubMed  Google Scholar 

  24. Fung HC, Stein A, Slovak M, O'donnell MR, Snyder DS, Cohen S et al. A long-term follow-up report on allogeneic stem cell transplantation for patients with primary refractory acute myelogenous leukemia: impact of cytogenetic characteristics on transplantation outcome. Biol Blood Marrow Transplant 2003; 9: 766–771.

    Article  CAS  PubMed  Google Scholar 

  25. 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 

  26. Sorror ML, Sandmaier BM, Storer BE, Maris MB, Baron F, Maloney DG et al. Comorbidity and disease status based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol 2007; 25: 4246–4254.

    Article  PubMed  Google Scholar 

  27. Savic A, Kvrgic V, Rajic N, Urosevic I, Kovacevic D, Percic I et al. The hematopoietic cell transplantation comorbidity index is a predictor of early death and survival in adult acute myeloid leukemia patients. Leuk Res 2012; 36: 479–482.

    Article  PubMed  Google Scholar 

  28. Birninger N, Bornhäuser M, Schaich M, Ehninger G, Schetelig J . The hematopoietic cell transplantation-specific comorbidity index fails to predict outcomes in high-risk AML patients undergoing allogeneic transplantation—investigation of potential limitations of the index. Biol Blood Marrow Transplant 2011; 17: 1822–1832.

    Article  PubMed  Google Scholar 

  29. Valcárcel D, Martino R, Caballero D, Martin J, Ferra C, Nieto JB et al. Sustained remissions of high-risk acute myeloid leukemia and myelodysplastic syndrome after reduced-intensity conditioning allogeneic hematopoietic transplantation: chronic graft-versus-host disease is the strongest factor improving survival. J Clin Oncol 2008; 26: 577–584.

    Article  PubMed  Google Scholar 

  30. Tauro S, Craddock C, Peggs K, Begum G, Mahendra P, Cook G et al. Allogeneic stem-cell transplantation using a reduced-intensity conditioning regimen has the capacity to produce durable remissions and long-term disease-free survival in patients with high-risk acute myeloid leukemia and myelodysplasia. J Clin Oncol 2005; 23: 9387–9393.

    Article  CAS  PubMed  Google Scholar 

  31. 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 leukaemia: a retrospective survey from the Acute Leukemia Working Party (ALWP) of the European group for Blood and Marrow Transplantation (EBMT). Leukemia 2005; 19: 2304–2312.

    Article  CAS  PubMed  Google Scholar 

  32. Alyea EP, Kim HT, Ho V, Cutler C, Gribben J, DeAngelo DJ et al. Comparative outcome of nonmyeloablative and myeloablative allogeneic hematopoietic cell transplantation for patients older than 50 years of age. Blood 2005; 105: 1810–1814.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors gratefully acknowledge receipt of unrestricted financial support by Otsuka America Pharmaceuticals Inc. to cover the cost of data collection and analysis.

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Authors and Affiliations

  1. Allogeneic Blood and Marrow Transplant Program, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada

    F V Michelis, V Gupta, D D Kim, J Kuruvilla, A Lambie, J H Lipton, D Loach & H A Messner

  2. Department of Biostatistics, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada

    E G Atenafu

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  1. F V Michelis
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Correspondence to H A Messner.

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We would like to disclose the financial support by Otsuka America Pharmaceuticals, Inc. for data collection and analysis.

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Michelis, F., Atenafu, E., Gupta, V. et al. Duration of first remission, hematopoietic cell transplantation-specific comorbidity index and patient age predict survival of patients with AML transplanted in second CR. Bone Marrow Transplant 48, 1450–1455 (2013). https://doi.org/10.1038/bmt.2013.71

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