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Allogeneic stem cell transplantation for refractory acute myeloid leukemia: a single center analysis of long‐term outcome
Author(s) -
Hemmati Philipp G.,
Terwey Theis H.,
Na IlKang,
Jehn Christian F.,
Coutre Philipp,
Vuong Lam G.,
Dörken Bernd,
Arnold Renate
Publication year - 2015
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12522
Subject(s) - medicine , single center , myeloid leukemia , refractory (planetary science) , transplantation , surgery , leukemia , incidence (geometry) , gastroenterology , salvage therapy , graft versus host disease , acute leukemia , chemotherapy , physics , astrobiology , optics
Abstract For patients with refractory acute myeloid leukemia ( AML ), allogeneic stem cell transplantation (allo SCT ) represents the only curative approach. We here analyzed the long‐term outcome of 131 consecutive patients with active AML , which was either primary refractory or unresponsive to salvage chemotherapy, transplanted at our center between 1997 and 2013. After a median follow‐up of 48 months for the surviving patients, disease‐free survival ( DFS ) at 5 yr post allo SCT was 26% (94% CI : 17–35). Relapses, most of which occurred within the first 2 yr from transplant, were the predominant cause of treatment failure affecting 48% (95% CI : 40–58) of patients, whereas non‐relapse mortality was 26% (95% CI : 20–36) at 5 yr and thereafter. A marrow blast count ≥20% before allo SCT was an independent prognosticator associated with an inferior DFS ( HR : 1.58, P = 0.027), whereas the development of chronic graft‐ versus ‐host disease ( cGvHD ) predicted an improved DFS ( HR 0.21, P < 0.001) and a decreased relapse incidence ( HR : 0.18, P = 0.026), respectively. These results indicate that allo SCT represents a curative treatment option in a substantial proportion of patients with refractory AML . A pretransplant blast count <20% before allo SCT and the development of cGvHD are the most important predictors of long‐term disease control.