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Cytogenetic risk determines outcomes after allogeneic transplantation in older patients with acute myeloid leukemia in their second complete remission: A Center for I nternational B lood and M arrow T ransplant R esearch cohort analysis
Author(s) -
Michelis Fotios V.,
Gupta Vikas,
Zhang MeiJie,
Wang HaiLin,
Aljurf Mahmoud,
Bacher Ulrike,
Beitinjaneh Amer,
Chen YiBin,
DeFilipp Zachariah,
Gale Robert Peter,
Kebriaei Partow,
KharfanDabaja Mohamed,
Lazarus Hillard M.,
Nishihori Taiga,
Olsson Richard F.,
Oran Betul,
Rashidi Armin,
Rizzieri David A.,
Tallman Martin S.,
de Lima Marcos,
Khoury H. Jean,
Sandmaier Brenda M.,
Weisdorf Daniel,
Saber Wael
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30567
Subject(s) - medicine , myeloid leukemia , transplantation , leukemia , oncology , myeloid , single center , immunology
BACKGROUND Allogeneic hematopoietic cell transplantation (HCT) offers curative potential to a number of older patients with acute myeloid leukemia (AML) in their first complete remission. However, there are limited data in the literature concerning post‐HCT outcomes for older patients in their second complete remission (CR2). METHODS The purpose of the current study was to retrospectively investigate within the Center for International Blood and Marrow Transplant Research database parameters influencing posttransplant outcomes for patients 60 years of age or older undergoing HCT for AML in CR2. RESULTS In total, 196 patients from 78 centers were identified; the median age was 64 years (range, 60‐78 years). Seventy‐one percent had a Karnofsky performance status ≥ 90 at the time of HCT. Reduced‐intensity conditioning regimens were used in 159 patients (81%). A univariate analysis demonstrated a 3‐year overall survival (OS) rate of 42% (95% confidence interval [CI], 35%‐49%), a leukemia‐free survival rate of 37% (95% CI, 30%‐44%), a cumulative incidence of nonrelapse mortality of 25% (95% CI, 19%‐32%), and a cumulative incidence of relapse (CIR) of 38% (95% CI, 31%‐45%). A multivariate analysis demonstrated that cytogenetic risk was the only independent risk factor for OS ( P = .023) with a hazard ratio (HR) of 1.14 (95% CI, 0.59‐2.19) for intermediate‐risk cytogenetics and an HR of 2.32 (95% CI, 1.05‐5.14) for unfavorable‐risk cytogenetics. For CIR, cytogenetic risk was also the only independent prognostic factor ( P = .01) with an HR of 1.10 (95% CI, 0.47‐2.56) for intermediate‐risk cytogenetics and an HR of 2.98 (95% CI, 1.11‐8.00) for unfavorable‐risk cytogenetics. CONCLUSIONS Allogeneic HCT is a curative treatment option for older patients with AML in CR2, particularly for those with favorable or intermediate cytogenetic risk. Cancer 2017;123:2035–2042 . © 2017 American Cancer Society .