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History of consolidation is prognostic in acute myeloid leukemia patients undergoing allogeneic hematopoietic cell transplantation in minimal residual disease‐negative first complete remission
Author(s) -
Rashidi Armin,
Linden Michael A.,
DeFor Todd E.,
Warlick Erica,
Bejanyan Nelli,
Yohe Sophia,
Weisdorf Daniel J.,
Ustun Celalettin
Publication year - 2017
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.24834
Subject(s) - medicine , minimal residual disease , hazard ratio , oncology , transplantation , hematopoietic stem cell transplantation , myeloid leukemia , leukemia , myeloid , confidence interval , surgery
Background Prognostic factors among acute myeloid leukemia (AML) patients undergoing allogeneic hematopoietic cell transplantation (allo‐HCT) in minimal residual disease (MRD)‐negative first complete remission (CR1) are unknown. We retrospectively attempted to answer the following question: In AML patients undergoing allo‐HCT in MRD‐negative CR1, does a history of prior consolidation provide additional prognostic information? Methods The inclusion criteria were: ( i ) Age > 18 years, ( ii ) AML in CR1 after 1‐2 cycles of intensive induction chemotherapy, with or without consolidation, ( iii ) Allo‐HCT between 1/2003 and 4/2016 at our institution, ( iv ) Available standard‐sensitivity 4‐color flow cytometry results from a bone marrow aspiration at diagnosis and after completion of all previous chemotherapy within one month prior to HCT, ( v ) Flow cytometry‐based MRD‐negative status at the time of HCT. Results A history of prior consolidation was associated with favorable overall survival (Hazard Ratio [95% Confidence Interval]: 0.59 [0.35‐0.99], P = .046), relapse‐free survival (0.60 [0.37‐0.96], P = .036), and relapse (0.50 [0.27‐0.92], P = .025). Analysis of potential sources of bias was unrevealing. Conclusions In AML patients undergoing allo‐HCT in MRD‐negative CR1, a history of prior consolidation was associated with favorable outcomes. If the path to pre‐HCT MRD negativity includes consolidation, it may identify patients with improved prognosis following HCT in MRD‐negative state. These results warrant validation in larger cohorts.