Work

Post-Hematopoietic Stem Cell Transplantation (HSCT) Outcomes in Patients With AML Transplanted Prior to Achieving Platelet Recovery

Year: 2009

Type: article

Abstract: Reduced intensity conditioning (RIC) allowed to offer allogeneic stem cell transplantation (alloSCT) to patients ineligible to standard conditioning.In addition to a number of disease-specific variables, the presence of comorbidities, as assessed by the hematopoietic cell transplantation-specific comorbidity index (HCT-CI), and transplantation-associated factors affect the outcome of these patients following allSCT.We therefore investigated whether a combined risk-factor analysis predicts the overall outcome of patients with AML following RIC-alloSCT.90 patients with AML who underwent alloSCT at our institution were analyzed.50/90 patients (56%) were in CR1, 12/90 (15%) were in .CR1, and 26/90 (29%) had active disease.4/90 patients (4%) had a favorable-risk karyotype, 51/90 patients (57%) or 29/90 patients (32%) had an intermediaterisk or a poor-risk karyotype.18/90 (20%) patients had an intermediate-risk HCT-CI and 72/90 patients (80%) had an unfavorable score.38/90 patients (42%) were transplanted from a matchedrelated donor.A matched-unrelated or a mismatched-unrelated donor was available in 36/90 patients (40%) or in 16/90 patients (18%).As a preparative regimen all patients received RIC (fludarabine 180 mg/m2 1 oral busulfane 8 mg/kg 1 antithymocyte globulin 40 mg/kg).Overall survival (OS) or disease-free survival (DFS) of all patients at 1, 3, and 5 years was 60%, 44%, and 44% or 56%, 46%, and 46%.49/90 patients (54%) are in CR.Causes of death were relapse (23/90 patients (26%)) or TRM (18/90 patients (20%)).Depending on the presence or absence of at least one leukemiaspecific risk-factor (tAML, unfavorable-risk karyotype, .CR1) or transplantation-related risk-factor (alloSCT from a mismatched or an unrelated donor), patients were grouped into four subgroups: group I (HCT-CI # 4, no high-risk), group II (HCT-CI .4,no high-risk), group III (HCT-CI # 4, high-risk), and group IV (HCT-CI .4,high-risk).Projected OS in at 1, 2, and 4 years after alloSCT was 75%, 63%, and 63% (group I), 100%, 67%, and 67% (group II), 58%, 45%, and 36% (group III), or 31%, 15%, and 15% (group IV), which differed significantly between the subgroups (p 5 0.01).There was no statistically significant difference in TRM between the subgroups (p 5 0.27).This indicates that a combined risk-factor analysis incorporating disease-specific variables, transplantation-related factors, and comorbidities may predict the overall outcome of patients with AML after RIC-alloSCT.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2008.12.181