Predictors of Outcomes of Therapy-Related Acute Myeloid Leukemia After Allogeneic Hematopoietic Stem Cell Transplantation.

Q1 Medicine

Hematology/ Oncology and Stem Cell Therapy Pub Date : 2022-03-01 DOI:10.1016/j.hemonc.2021.03.003

Ram Vasudevan Nampoothiri, Arjun Datt Law, Wilson Lam, Carol Chen, Zeyad Al-Shaibani, David Loach, Fotios V Michelis, Dennis Dong Hwan Kim, Jonas Mattsson, Rajat Kumar, Jeffrey Howard Lipton, Auro Viswabandya

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引用次数: 5

Abstract

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 FLAGI-da 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.

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异基因造血干细胞移植后治疗相关性急性髓系白血病预后的预测因素。

背景/目的:同种异体造血干细胞移植(allogeneic hematopoietic stem cell transplantation, alloo - hsct)治疗相关急性髓系白血病(acute myeloid leukemia, t-AML)的现有文献因纳入继发性AML和t-MDS患者而存在混淆。我们的目标是报告我们在t-AML中进行HSCT治疗的20年经验。方法:我们回顾性分析了接受HSCT治疗的t-AML患者。分析患者的既往恶性肿瘤、治疗、诊断t-AML的时间、移植细节、无复发生存期(RFS)、总生存期(OS)和预后预测因子。结果:共68例患者(女性59.9%;中位年龄56.5岁)接受了HSCT。急性和慢性移植物抗宿主病(GVHD)分别发生39例(57.4%)和23例(33.8%)。2年累计复发率、非复发死亡率、RFS和OS分别为17.9%、34.5%、47.6%和49.3%。11q23重排的存在(风险比[HR]， 3.24)，使用FLAGI-da或7 + 3以外的诱导方案(风险比，3.65)，单倍体相同供体(风险比，3.48)，东部肿瘤合作组表现状态2或更高(风险比，5.83)，以及使用环孢素a -甲氨甲呤作为GVHD预防(风险比，2.41)是降低OS的重要预测因素。随着这些预后因素数量的增加，生存率显著下降。结论:同种异体造血干细胞移植后t-AML治疗效果满意。具有高风险核型、良好表现状态、hla匹配供体和接受强化诱导方案的t-AML患者在HSCT后具有更好的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hematology/ Oncology and Stem Cell Therapy Medicine-Hematology

CiteScore

4.30

自引率

0.00%

发文量

审稿时长

27 weeks

期刊介绍： Hematology Oncology and Stem Cell Therapy is an international, peer-reviewed, open access journal that provides a vehicle for publications of high-quality clinical as well as basic science research reports in hematology and oncology. The contents of the journal also emphasize the growing importance of hematopoietic stem cell therapy for treatment of various benign and malignant hematologic disorders and certain solid tumors.The journal prioritizes publication of original research articles but also would give consideration for brief reports, review articles, special communications, and unique case reports. It also offers a special section for clinically relevant images that provide an important educational value.