Predictors of outcomes of therapy-related acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation
| Autor: | Rajat Kumar, Dennis Dong Hwan Kim, Jonas Mattsson, David Loach, Arjun Datt Law, Zeyad Al-Shaibani, Carol Chen, Wilson Lam, Fotios V. Michelis, Jeffrey H. Lipton, Auro Viswabandya, Ram V Nampoothiri |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Oncology medicine.medical_specialty Transplantation Conditioning medicine.medical_treatment Graft vs Host Disease Therapy-Related Acute Myeloid Leukemia Disease Hematopoietic stem cell transplantation Malignancy Recurrence hemic and lymphatic diseases Internal medicine medicine Humans Cumulative incidence Retrospective Studies Performance status business.industry Hazard ratio Hematopoietic Stem Cell Transplantation Myeloid leukemia Hematology General Medicine Middle Aged medicine.disease Leukemia Myeloid Acute Methotrexate surgical procedures operative Cyclosporine Female Unrelated Donors business |
| Zdroj: | Hematology/Oncology and Stem Cell Therapy. |
| ISSN: | 1658-3876 |
| Popis: | Background/Objective Existing literature on allogeneic hematopoietic stem cell transplantation (allo-HSCT) in therapy-related acute myeloid leukemia (t-AML) is confounded by the inclusion of patients with secondary AML and t-MDS. We aim to report our 20-year experience of HSCT in t-AML. Methods We retrospectively reviewed patients with t-AML who underwent HSCT. Patients were analyzed for prior malignancy, therapy, time to diagnosis of t-AML, transplant details, relapse-free survival (RFS), overall survival (OS), and predictors of outcomes. Results In total, 68 patients (59.9% female; median age, 56.5 years) underwent HSCT. Acute and chronic graft-versus-host disease (GVHD) occurred in 39 (57.4%) and 23 (33.8%) patients, respectively. Cumulative incidence of relapse, nonrelapse mortality, RFS, and OS at 2 years were 17.9%, 34.5%, 47.6%, and 49.3%, respectively. Significant predictors of reduced OS were presence of 11q23 rearrangement (hazard ratio [HR], 3.24), using induction regimens other than FLAG-Ida or 7 + 3 (HR, 3.65), haploidentical donors (HR, 3.48), Eastern Cooperative Oncology Group performance status 2 or higher (HR, 5.83), and using cyclosporine A–methotrexate as GVHD prophylaxis (HR, 2.41). A significant decrement in survival was seen with an increasing number of any of these prognostic factors. Conclusion Outcomes of t-AML are satisfactory after allo-HSCT. Patients with t-AML with good-risk karyotypes, good performance status, having HLA-matched donors, and receiving intensive induction regimens have better outcomes after HSCT. |
| Databáze: | OpenAIRE |
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