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Relapse and survival after transplantation for complex karyotype acute myeloid leukemia: A report from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation and the University of Texas MD Anderson Cancer Center
Author(s) -
Ciurea Stefan O.,
Labopin Myriam,
Socie Gerard,
Volin Liisa,
Passweg Jakob,
Chevallier Patrice,
Beelen Dietrich,
Milpied Noel,
Blaise Didier,
Cornelissen Jan J.,
Fegueux Nathalie,
Polge Emmanuelle,
Kongtim Piyanuch,
Rondon Gabriela,
Esteve Jordi,
Mohty Mohamad,
Savani Bipin N.,
Champlin Richard E.,
Nagler Ar
Publication year - 2018
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.31311
Subject(s) - medicine , transplantation , myeloid leukemia , hazard ratio , acute leukemia , leukemia , monosomy , oncology , hematopoietic stem cell transplantation , gastroenterology , immunology , karyotype , biology , confidence interval , chromosome , genetics , gene
BACKGROUND Despite recent advances in allogeneic hematopoietic stem cell transplantation (AHSCT), the outcome of patients who have acute myeloid leukemia (AML) with a complex karyotype (CK) remains poor. The objective of this study was to identify prognostic factors associated with post‐transplantation survival in a large cohort of patients with CK AML. METHODS In total, data on 1342 consecutively patients who underwent transplantation for CK (≥3 chromosomal abnormalities) AML were provided by the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation and from the University of Texas MD Anderson Cancer Center database were included in the analysis. The median patient age was 52 years. The donors were human leukocyte antigen‐matched related donors (N = 749), matched unrelated donors (N = 513), and mismatched unrelated donors (N = 80). RESULTS Relapse was the main cause of treatment failure. Overall, 51% of patients relapsed, 17.6% died of treatment‐related mortality, and 31.3% survived leukemia‐free. In multivariate analysis, the factors associated with an increased risk of relapse were age (>40 years; hazard ratio [HR], 1.1 per 10 years; P = .02), secondary AML (HR, 1.35; P = .01), active disease at transplantation (HR, 1.98; P < .001), and deletion/monosomy 5 (HR, 1.5; P < .001); whereas age (HR, 1.15 per 10 years; P < .001), secondary AML (HR, 1.36; P = .001), active disease at transplantation (HR, 1.99; P < .001), deletion/monosomy 5 (HR, 1.24; P = .008), and deletion/monosomy 7 (HR, 1.44; P < .001) predicted for leukemia‐free survival. CONCLUSIONS Disease relapse remains the most common cause of treatment failure for patients with CK AML after transplantation. Novel approaches to decrease the relapse rate and improve survival are needed in these patients. Cancer 2018;124:2134‐41 . © 2018 American Cancer Society .