Long-Term Outcomes After Autologous Versus Allogeneic Stem Cell Transplantation in Molecularly-Stratified Patients With Intermediate Cytogenetic Risk Acute Myeloid Leukemia: A PETHEMA Study
| Autor: | Rodríguez-Arbolí, Eduardo, Martínez-Cuadrón, David, Rodríguez-Veiga, Rebeca, Carrillo-Cruz, Estrella, Gil-Cortés, Cristina, Serrano-López, Josefina, Bernal Del Castillo, Teresa, Martínez-Sánchez, María Del Pilar, Rodríguez-Medina, Carlos, Vidriales, Belén, Bergua, Juan Miguel, Benavente, Celina, García-Boyero, Raimundo, Herrera-Puente, Pilar, Algarra, Lorenzo, Sayas-Lloris, María José, Fernández, Rosa, Labrador, Jorge, Lavilla-Rubira, Esperanza, Barrios-García, Manuel, Tormo, Mar, Serrano-Maestro, Alfons, Sossa-Melo, Claudia Lucía, García-Belmonte, Daniel, Vives, Susana, Rodríguez-Gutiérrez, Juan Ignacio, Albo-López, Carmen, Garrastazul-Sánchez, María Paz, Colorado-Araujo, Mercedes, Mariz, José, Sanz, Miguel Ángel, Pérez-Simón, José Antonio, Montesinos, Pau, PETHEMA (Programa Español de Tratamientos en Hematología) and GETH (Grupo Español de Trasplante Hematopoyético y Terapia Celular) Cooperative Groups |
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| Přispěvatelé: | Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red Cáncer (España) |
| Rok vydání: | 2020 |
| Předmět: |
Oncology
medicine.medical_specialty NPM1 European LeukemiaNet Internal medicine CEBPA Immunology and Allergy Medicine Humans Transplantation Homologous Cumulative incidence Transplantation Acute myeloid leukemia business.industry Remission Induction Hematopoietic Stem Cell Transplantation Myeloid leukemia Cell Biology Hematology Confidence interval Allogeneic stem cell transplant Leukemia Myeloid Acute Autologous stem cell transplant Cytogenetic Analysis Molecular Medicine Stem cell business Nucleophosmin |
| Zdroj: | Digital.CSIC. Repositorio Institucional del CSIC instname |
| ISSN: | 2666-6367 |
| Popis: | PETHEMA (Programa Español de Tratamientos en Hematología) and GETH (Grupo Espa~nol de Trasplante Hematopoyético y Terapia Celular) Cooperative Groups Acute myeloid leukemia (AML) with intermediate risk cytogenetics (IRcyto) comprises a variety of biological entities with distinct mutational landscapes that translate into differential risks of relapse and prognosis. Optimal postremission therapy choice in this heterogeneous patient population is currently unsettled. In the current study, we compared outcomes in IRcyto AML recipients of autologous (autoSCT) (n = 312) or allogeneic stem cell transplantation (alloSCT) (n = 279) in first complete remission (CR1). Molecular risk was defined based on CEBPA, NPM1, and FLT3-ITD mutational status, per European LeukemiaNet 2017 criteria. Five-year overall survival (OS) in patients with favorable molecular risk (FRmol) was 62% (95% confidence interval [CI], 50-72) after autoSCT and 66% (95% CI, 41-83) after matched sibling donor (MSD) alloSCT (P = .68). For patients of intermediate molecular risk (IRmol), MSD alloSCT was associated with lower cumulative incidence of relapse (P < .001), as well as with increased nonrelapse mortality (P = .01), as compared to autoSCT. The 5-year OS was 47% (95% CI, 34-58) after autoSCT and 70% (95% CI, 59-79) after MSD alloSCT (P = .02) in this patient subgroup. In a propensity-score matched IRmol subcohort (n = 106), MSD alloSCT was associated with superior leukemia-free survival (hazard ratio [HR] 0.33, P = .004) and increased OS in patients alive 1 year after transplantation (HR 0.20, P = .004). These results indicate that, within IRcyto AML in CR1, autoSCT may be a valid option for FRmol patients, whereas MSD alloSCT should be the preferred postremission strategy in IRmol patients. Supported by a Río Hortega academic clinical fellowship (CM19/00194) from the Instituto de Salud Carlos III, Spain (E.R.A.). Additional funding has been provided by CIBERONC grants to J.P.S. (CB16/12/00480), M.M.S. (CB16/12/00369) and B.V. (CB16/12/00233). |
| Databáze: | OpenAIRE |
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