Stem cell transplantation for secondary acute myeloid leukemia: evaluation of transplantation as initial therapy or following induction chemotherapy
| Autor: | J E, Anderson, T A, Gooley, G, Schoch, C, Anasetti, W I, Bensinger, R A, Clift, J A, Hansen, J E, Sanders, R, Storb, F R, Appelbaum |
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| Rok vydání: | 1997 |
| Předmět: |
Adult
Leukemia Radiation-Induced Male Transplantation Conditioning Adolescent Radiotherapy Remission Induction Hematopoietic Stem Cell Transplantation Neoplasms Second Primary Middle Aged Disease-Free Survival Treatment Outcome Leukemia Myeloid Myelodysplastic Syndromes Neoplasms Antineoplastic Combined Chemotherapy Protocols Disease Progression Humans Female Life Tables Child Proportional Hazards Models Retrospective Studies |
| Zdroj: | Blood. 89(7) |
| ISSN: | 0006-4971 |
| Popis: | The purpose of this report is to describe the results of stem cell transplantation as initial treatment for secondary acute myeloid leukemia (AML). Forty-six patients (median age 42 years) with secondary AML (17 therapy-related, 29 myelodysplasia-related) who had not received remission induction chemotherapy underwent allogeneic (n = 43) or syngeneic (n = 3) transplantation. The 5-year actuarial disease-free survival was 24.4%, and the cumulative incidences of relapse and nonrelapse mortality were 31.3% and 44.3%, respectively. Lower peripheral blood blast count was associated with a lower risk of relapse (P = .05) and shorter time from AML diagnosis to transplant was associated with a lower risk of nonrelapse mortality (P = .02) and improved disease-free survival (P = .026). Patients with therapy-related secondary AML tended to have lower disease-free survival (P = .16) and a higher relapse rate (P = .16) than patients whose leukemia was not therapy-related. The results of these 46 previously untreated patients were compared to 20 patients (median age 36 years, 12 therapy-related, 8 myelodysplasia-related) transplanted with chemotherapy-sensitive disease after induction chemotherapy (first complete remission [n = 6], second complete remission [n = 3], first untreated relapse [n = 11]). We found no statistically significant difference in outcome between these 2 groups of patients. These results suggest that prompt transplantation should be considered after diagnosis of secondary AML or, if possible, high-risk myelodysplasia, particularly in patients with low peripheral blast counts. Innovative transplant strategies are needed to reduce the high risks of relapse and nonrelapse mortality seen in this patient population. |
| Databáze: | OpenAIRE |
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