Role of allogeneic transplantation in chronic myelomonocytic leukemia: an international collaborative analysis
Year: 2022
Type: article
Study design: Observational Study
Abstract: To determine the survival benefit of allogeneic hematopoietic cell transplantation (allo-HCT) in chronic myelomonocytic leukemias (CMML), we assembled a retrospective cohort of CMML patients 18-70 years old diagnosed between 2000 and 2014 from an international CMML dataset (n = 730) and the EBMT registry (n = 384). The prognostic impact of allo-HCT was analyzed through univariable and multivariable time-dependent models and with a multistate model, accounting for age, sex, CMML prognostic scoring system (low or intermediate-1 grouped as lower-risk, intermediate-2 or high as higher-risk) at diagnosis, and AML transformation. In univariable analysis, lower-risk CMMLs had a 5-year overall survival (OS) of 20% with allo-HCT vs 42% without allo-HCT (P < .001). In higher-risk patients, 5-year OS was 27% with allo-HCT vs 15% without allo-HCT (P = .13). With multistate models, performing allo-HCT before AML transformation reduced OS in patients with lower-risk CMML, and a survival benefit was predicted for men with higher-risk CMML. In a multivariable analysis of lower-risk patients, performing allo-HCT before transformation to AML significantly increased the risk of death within 2 years of transplantation (hazard ratio [HR], 3.19; P < .001), with no significant change in long-term survival beyond this time point (HR, 0.98; P = .92). In higher-risk patients, allo-HCT significantly increased the risk of death in the first 2 years after transplant (HR 1.46; P = .01) but not beyond (HR, 0.60; P = .09). Performing allo-HCT before AML transformation decreases life expectancy in lower-risk patients but may be considered in higher-risk patients.
Source: Blood
Authors: Marie Robin, Liesbeth C. de Wreede, Eric Padron, Katerina Bakunina, Pierre Fenaux, Linda Koster, Aziz Nazha, Dietrich W. Beelen, Raajit K. Rampal, Katja Sockel, Rami S. Komrokji, Nico Gagelmann, Dirk-Jan Eikema, Aleksandar Radujkovic, Jürgen Finke, Victoria Potter, Sally B. Killick, Faezeh Legrand, Eric Solary, Angus Broom, Guillermo Garcia-Manero, Vittorio Rizzoli, Patrick Hayden, Mrinal M. Patnaik, Francesco Onida, Ibrahim Yakoub-Agha, Raphael Itzykson
Institutions: Hôpital Saint-Louis, Leiden University Medical Center, Moffitt Cancer Center, European Society for Blood and Marrow Transplantation, Assistance Publique – Hôpitaux de Paris, Cleveland Clinic, Essen University Hospital, Memorial Sloan Kettering Cancer Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, University Medical Center Hamburg-Eppendorf, Heidelberg University, University Hospital Heidelberg, University Medical Center Freiburg, National Health Service, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Centre de Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, Inserm, Université Paris-Saclay, Western General Hospital, The University of Texas MD Anderson Cancer Center, Trinity College Dublin, St. James's Hospital, Mayo Clinic, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Université de Lille, Centre Hospitalier Universitaire de Lille, Institute for Translational Research in Inflammation, Centre National de la Recherche Scientifique, Université Paris Cité, Génomes, biologie cellulaire et thérapeutiques, Laboratoire d'hématologie
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4282921810