Measurable residual disease, conditioning regimen intensity, and age predict outcome of allogeneic hematopoietic cell transplantation for acute myeloid leukemia in first remission: A registry analysis of 2292 patients by the Acute Leukemia Working Party E
| Autor: | Bipin N. Savani, Ibrahim Yakoub-Agha, Arnon Nagler, Myriam Labopin, Per Ljungman, Eric Deconinck, Jean Bourhis, Mohamad Mohty, Liisa Volin, Depei Wu, Gérard Socié, Emmanuelle Polge, Jean-Yves Cahn, Maria H. Gilleece, Anne Huynh |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Oncology Acute promyelocytic leukemia medicine.medical_specialty Neoplasm Residual Transplantation Conditioning Myeloid Graft vs Host Disease Young Adult 03 medical and health sciences 0302 clinical medicine Immunophenotyping Recurrence hemic and lymphatic diseases Internal medicine medicine Humans Transplantation Homologous Registries Survival analysis Aged Retrospective Studies Acute leukemia business.industry Remission Induction Age Factors Hematopoietic Stem Cell Transplantation Myeloid leukemia Hematology Middle Aged Prognosis medicine.disease Survival Analysis 3. Good health Europe body regions Transplantation Leukemia Myeloid Acute Leukemia medicine.anatomical_structure 030220 oncology & carcinogenesis business 030215 immunology |
| Zdroj: | American Journal of Hematology. 93:1142-1152 |
| ISSN: | 0361-8609 |
| Popis: | Patients with acute myeloid leukemia (AML) in morphological first complete remission (CR1) pre-allogeneic hematopoietic cell transplantation (HCT) may have measurable residual disease (MRD) by molecular and immunophenotyping criteria. We assessed interactions of MRD status with HCT conditioning regimen intensity in patients aged50 years (y) or ≥50y. This was a retrospective study by the European Society for Blood and Marrow Transplantation registry. Patients were18y with AML CR1 MRD NEG/POS and recipients of HCT in 2000-2015. Conditioning regimens were myeloablative (MAC), reduced intensity (RIC) or non-myeloablative (NMA). Outcomes included leukemia free survival (LFS), overall survival (OS), relapse incidence (RI), non-relapse mortality (NRM), chronic graft-vs-host (cGVHD), and GVHD-free and relapse-free survival (GRFS). The 2292 eligible patients were categorized into four paired groups:50y MRD POS MAC (N = 240) vs RIC/NMA (N = 58);50y MRD NEG MAC (N = 665) vs RIC/NMA (N = 195); ≥50y MRD POS MAC (N = 126) vs RIC/NMA (N = 230), and ≥50y MRD NEG MAC (N = 223) vs RIC/NMA (N = 555). In multivariate analysis RIC/NMA was only inferior to MAC for patients in the50y MRD POS group, with worse RI (HR 1.71) and LFS (HR 1.554). Patients50Y MRD NEG had less cGVHD after RIC/NMA HCT (HR 0.714). GRFS was not significantly affected by conditioning intensity in any group. Patients aged50y with AML CR1 MRD POS status should preferentially be offered MAC allo-HCT. Prospective studies are needed to address whether patients with AML CR1 MRD NEG may be spared the toxicity of MAC regimens. New approaches are needed for ≥50y AML CR1 MRD POS. |
| Databáze: | OpenAIRE |
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