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Ye W, Wu X, Zhao R, Jin X, Li H, Qu Y, Ji J, Liu Z. Comparison of allo-SCT, auto-SCT and chemotherapy for the treatment of patients with low- or intermediate-risk acute myeloid leukemia: a network meta-analysis. Stem Cell Res Ther 2024; 15:153. [PMID: 38816870 PMCID: PMC11141018 DOI: 10.1186/s13287-024-03766-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/18/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND The therapeutic status of allogeneic stem cell transplantation (allo-SCT) as a post-remission treatment for patients with high-risk acute myeloid leukemia (AML) was well-accepted. However, the optimal treatment for patients with low/favorable- or intermediate-risk AML who achieve complete remission has remained controversial. Therefore, we conducted a network meta-analysis to discuss this disputed problem. METHODS We compared the effects of treatment strategies including allo-SCT, autologous stem cell transplantation (auto-SCT) and consolidation chemotherapy (CT) for patients with low/favorable- or intermediate-risk AML. The pooled HRs and 95% CIs for overall survival and disease-free survival were estimated with Stata12 and R software. Thirty clinical studies with 6682 patients were included in the meta-analysis. RESULTS The results indicated that the treatment outcome of allo-SCT was the best, followed by auto-SCT, and CT was likely the worst in the total AML patients. In patients with low/favorable-risk AML, the treatment outcome of auto-SCT was likely ranked first, followed by allo-SCT, and CT was the worst. In patients with intermediate-risk AML, the treatment outcome of haploidentical stem cell transplantation (haplo-SCT) was the best, followed by allo-SCT (excluding haplo-SCT), and auto-SCT and CT were the worst. However, the median age of the haplo-SCT group was much younger than that of the control group, which may be one of the reasons for the better prognosis of the haplo-SCT group. CONCLUSIONS Patients with low/favorable- and intermediate-risk (non-high-risk) AML should prioritize allo-SCT if they are eligible for transplantation, and auto-SCT is optional. However, in the subgroup analysis, auto-SCT was the optimal treatment choice for patients with low/favorable-risk AML, and allo-SCT was the priority selection for patients with intermediate-risk AML, especially young patients. These findings could provide references for clinical practice.
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Affiliation(s)
- Wu Ye
- Department of Hematology, West China Hospital, Sichuan University, No.37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Xia Wu
- Department of Hematology, West China Hospital, Sichuan University, No.37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Ruying Zhao
- Laminar Air-flow Research Unit of Clinical Trial Center, West China Hospital, Sichuan University, No.37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Xuelian Jin
- Department of Hematology, West China Hospital, Sichuan University, No.37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Hui Li
- Laminar Air-flow Research Unit of Clinical Trial Center, West China Hospital, Sichuan University, No.37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Ying Qu
- Department of Hematology, West China Hospital, Sichuan University, No.37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Jie Ji
- Department of Hematology, West China Hospital, Sichuan University, No.37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, China.
| | - Zhigang Liu
- Department of Hematology, West China Hospital, Sichuan University, No.37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, China.
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The evolving concept of indications for allogeneic hematopoietic cell transplantation during first complete remission of acute myeloid leukemia. Bone Marrow Transplant 2021; 56:1257-1265. [PMID: 33686251 DOI: 10.1038/s41409-021-01247-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/27/2021] [Accepted: 02/15/2021] [Indexed: 02/08/2023]
Abstract
The long-standing debate of whether patients with acute myeloid leukemia (AML) should proceed to allogeneic hematopoietic cell transplantation (HCT) during first complete remission (CR1) remains unsettled. Although allogeneic HCT during CR1 used to be recommended for those with intermediate or poor cytogenetics if they had a matched sibling donor, the concept of indications for allogeneic HCT during CR1 has been evolving by virtue of advances in understanding of the molecular pathogenesis of AML and innovations in transplantation practice attained over the last few decades. The incorporation of molecular profiles of leukemia has been shown to contribute to further refinements of risk classification that had previously relied mostly on cytogenetics, while the progress in transplantation procedures has made it possible to perform transplantations more safely even for patients without a matched sibling donor. These significant changes have underpinned the need to reappraise indications for allogeneic HCT during CR1 of AML. Improvements in clinical applications of genetic and measurable residual disease information as well as in transplantation technology are expected to further refine indications for allogeneic HCT during CR1, and thus promote an individualized approach for the treatment of AML.
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Bouvier A, Hamel JF, Delaunay J, Delabesse E, Dumas PY, Ledoux MP, Peterlin P, Luquet I, Roth Guepin G, Bulabois CE, Gallego Hernanz MP, Guillerm G, Guieze R, Hicheri Y, Simand C, Himberlin C, Hunault-Berger M, Bernard M, Jourdan E, Caillot D, Dorvaux V, Tavernier E, Daguindau E, Banos A, Ojeda-Uribe M, Gyan E, Alexis M, Marolleau JP, Turlure P, Bouscary D, Humbrecht C, Zerazhi H, Béné MC, Pigneux A, Carre M, Ifrah N, Blanchet O, Vey N, Récher C, Cornillet-Lefèbvre P. Molecular classification and prognosis in younger adults with acute myeloid leukemia and intermediate-risk cytogenetics treated or not by gemtuzumab ozogamycin: Final results of the GOELAMS/FILO acute myeloid leukemia 2006-intermediate-risk trial. Eur J Haematol 2021; 107:111-121. [PMID: 33765335 DOI: 10.1111/ejh.13626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/12/2022]
Abstract
In this randomized phase 3 study, the FILO group tested whether the addition of 6 mg/m2 of gemtuzumab ozogamycin (GO) to standard chemotherapy could improve outcome of younger patients with de novo acute myeloid leukemia (AML) and intermediate-risk cytogenetics. GO arm was prematurely closed after 254 inclusions because of toxicity. A similar complete remission rate was observed in both arms. Neither event-free survival nor overall survival were improved by GO in younger AML patients (<60 years) ineligible for allogeneic stem-cell transplantation. (P = .086; P = .149, respectively). Using unsupervised hierarchical clustering based on mutational analysis of seven genes (NPM1, FLT3-ITD, CEBPA, DNMT3A, IDH1, IDH2, and ASXL1), six clusters of patients with significant different outcome were identified. Five clusters were based on FLT3-ITD, NPM1, and CEBPA mutations as well as epigenetic modifiers (DNMT3A, IDH1/2, ASXL1), whereas the last cluster, representing 25% of patients, had no mutation and intermediate risk. One cluster isolated FLT3-ITD mutations with higher allelic ratio and a very poor outcome. The addition of GO had no impact in these molecular clusters. Although not conclusive for GO impact in AML patients <60 years, this study provides a molecular classification that distinguishes six AML clusters influencing prognosis in younger AML patients with intermediate-risk cytogenetic.
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Affiliation(s)
- Anne Bouvier
- Hématologie Biologique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Jean-François Hamel
- Departement de Biostatistiques, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Jacques Delaunay
- Hématologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Eric Delabesse
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopôle, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Pierre-Yves Dumas
- Hématologie Clinique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Marie-Pierre Ledoux
- Hématologie Clinique, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Pierre Peterlin
- Hématologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Isabelle Luquet
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopôle, Université Toulouse III Paul Sabatier, Toulouse, France
| | | | - Claude Eric Bulabois
- Hématologie Clinique, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | | | - Gaëlle Guillerm
- Hématologie Clinique, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Romain Guieze
- Hématologie Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Yosr Hicheri
- Hématologie Clinique, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Célestine Simand
- Hématologie Clinique, Institut cancérologique de Strasbourg Europe, Strasbourg, France
| | - Chantal Himberlin
- Hématologie Clinique, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Mathilde Hunault-Berger
- Hématologie clinique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Inserm, CRCINA, Angers, France
| | - Marc Bernard
- Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Eric Jourdan
- Hématologie Clinique, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Denis Caillot
- Hématologie Clinique, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Véronique Dorvaux
- Hématologie Clinique, Centre Hospitalier Régional de Metz, Metz, France
| | | | - Etienne Daguindau
- Hématologie Clinique, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Anne Banos
- Hématologie Clinique, Centre Hospitalier Côte Basque, Bayonne, France
| | - Mario Ojeda-Uribe
- Hématologie Clinique, Centre Hospitalier Regional de Mulhouse, Mulhouse, France
| | - Emmanuel Gyan
- Service d'Hématologie et thérapie cellulaire, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Magda Alexis
- Hématologie Clinique, Centre Hospitalier Régional Orléans, Orléans, France
| | | | - Pascal Turlure
- Hématologie Clinique, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | | | | | - Hacène Zerazhi
- Hématologie Clinique, Centre Hospitalier d'Avignon, Avignon, France
| | - Marie-Christine Béné
- Hématologie Biologique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Arnaud Pigneux
- Hématologie Clinique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Martin Carre
- Hématologie Clinique, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Norbert Ifrah
- Hématologie clinique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Inserm, CRCINA, Angers, France
| | - Odile Blanchet
- Hématologie Biologique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Norbert Vey
- Hématologie Clinique, Institut Paoli-Calmettes, Marseille, France
| | - Christian Récher
- Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopôle, Université Toulouse III Paul Sabatier, Toulouse, France
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Rodríguez-Arbolí E, Martínez-Cuadrón D, Rodríguez-Veiga R, Carrillo-Cruz E, Gil-Cortés C, Serrano-López J, Bernal Del Castillo T, Martínez-Sánchez MDP, Rodríguez-Medina C, Vidriales B, Bergua JM, Benavente C, García-Boyero R, Herrera-Puente P, Algarra L, Sayas-Lloris MJ, Fernández R, Labrador J, Lavilla-Rubira E, Barrios-García M, Tormo M, Serrano-Maestro A, Sossa-Melo CL, García-Belmonte D, Vives S, Rodríguez-Gutiérrez JI, Albo-López C, Garrastazul-Sánchez MP, Colorado-Araujo M, Mariz J, Sanz MÁ, Pérez-Simón JA, Montesinos P. Long-Term Outcomes After Autologous Versus Allogeneic Stem Cell Transplantation in Molecularly-Stratified Patients With Intermediate Cytogenetic Risk Acute Myeloid Leukemia: A PETHEMA Study. Transplant Cell Ther 2021; 27:311.e1-311.e10. [PMID: 33836871 DOI: 10.1016/j.jtct.2020.12.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/20/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
Abstract
Acute myeloid leukemia (AML) with intermediate risk cytogenetics (IRcyto) comprises a variety of biological entities with distinct mutational landscapes that translate into differential risks of relapse and prognosis. Optimal postremission therapy choice in this heterogeneous patient population is currently unsettled. In the current study, we compared outcomes in IRcyto AML recipients of autologous (autoSCT) (n = 312) or allogeneic stem cell transplantation (alloSCT) (n = 279) in first complete remission (CR1). Molecular risk was defined based on CEBPA, NPM1, and FLT3-ITD mutational status, per European LeukemiaNet 2017 criteria. Five-year overall survival (OS) in patients with favorable molecular risk (FRmol) was 62% (95% confidence interval [CI], 50-72) after autoSCT and 66% (95% CI, 41-83) after matched sibling donor (MSD) alloSCT (P = .68). For patients of intermediate molecular risk (IRmol), MSD alloSCT was associated with lower cumulative incidence of relapse (P < .001), as well as with increased nonrelapse mortality (P = .01), as compared to autoSCT. The 5-year OS was 47% (95% CI, 34-58) after autoSCT and 70% (95% CI, 59-79) after MSD alloSCT (P = .02) in this patient subgroup. In a propensity-score matched IRmol subcohort (n = 106), MSD alloSCT was associated with superior leukemia-free survival (hazard ratio [HR] 0.33, P = .004) and increased OS in patients alive 1 year after transplantation (HR 0.20, P = .004). These results indicate that, within IRcyto AML in CR1, autoSCT may be a valid option for FRmol patients, whereas MSD alloSCT should be the preferred postremission strategy in IRmol patients.
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Affiliation(s)
- Eduardo Rodríguez-Arbolí
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University of Seville, Seville, Spain
| | | | | | - Estrella Carrillo-Cruz
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University of Seville, Seville, Spain
| | - Cristina Gil-Cortés
- Department of Hematology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Josefina Serrano-López
- Department of Hematology, Reina Sofía University Hospital/Maimónides Biomedical Research Institute of Córdoba (IMIBIC)/University of Córdoba, Córdoba, Spain
| | | | | | - Carlos Rodríguez-Medina
- Department of Hematology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Belén Vidriales
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC- CB16/12/00233 and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Juan Miguel Bergua
- Department of Hematology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Celina Benavente
- Department of Hematology, Hospital Clínico San Carlos, Madrid, Spain
| | - Raimundo García-Boyero
- Department of Hematology, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | | | - Lorenzo Algarra
- Department of Hematology, Hospital General de Albacete, Albacete, Spain
| | | | - Rosa Fernández
- Department of Hematology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Jorge Labrador
- Department of Hematology and Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | | | | | - Mar Tormo
- Deparment of Hematology, Hospital Clínico Universitario de Valencia, Instituto de Investigación INCLIVA, Valencia, Spain
| | | | | | | | - Susana Vives
- Department of Hematology - ICO Hospital Germans Trias i Pujol , Josep Carreras Leukemia Research Institute, Badalona , Spain
| | | | - Carmen Albo-López
- Department of Hematology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | - José Mariz
- Department of Hematology, Instituto Português de Oncologia do Porto FG, Porto, Portugal
| | - Miguel Ángel Sanz
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
| | - José Antonio Pérez-Simón
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University of Seville, Seville, Spain.
| | - Pau Montesinos
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
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Bakaertas M, Yigenoglu N, Bascæ S, Ulu U, Ozcan N, Cakar K, Dal S, Altuntas F. Outcome of allogeneic stem cell transplantation with active disease in acute myeloid leukemia. SANAMED 2020. [DOI: 10.24125/sanamed.v15i1.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Despite multiple lines of chemotherapy, some patients with acute myeloid leukemia (AML) can not achieve remission. The prognosis of these patients is quite poor and they should be evaluated for clinical trials, otherwise myeloablative conditioning regimens followed by allogeneic stem cell transplantation (Allo-SCT) should be performed to overcome the active disease which is resistant to conventional doses and as it is the only curative option. Method: In this study, we evaluated the outcome of AML patients who underwent Allo-SCT with active disease in our center retrospectively. Results: A total of 161 AML patients underwent Allo-SCT between December 2009 and November 2018 at our center. 130 of them underwent Allo-SCT in complete remission while 31 of 161 had to undergo Allo-SCT with active disease due to refractoriness to salvage therapies. The median overall survival (OS) was 7.9 ± 2.8 months. 6-month OS was 25% and 1-year OS was only 6%. Progression-free survival (PFS) was 3.53 ± 1.1 months. The transplant-related mortality rate was 12.8%. Conclusion: OS and PFS are short in patients who undergo Allo-SCT with active disease so novel treatment approaches and targeted therapies should be developed to overcome active disease that are refractory to conventional chemotherapies.
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Montoro J, Ceberio I, Hilden P, Maloy MA, Barker J, Castro-Malaspina H, Dahi P, Koehne G, Perales MA, Ponce D, Sauter C, Shaffer B, Tamari R, Young JW, Giralt SA, O'Reilly RJ, Jakubowski AA, Papadopoulos EB. Ex Vivo T Cell-Depleted Hematopoietic Stem Cell Transplantation for Adult Patients with Acute Myelogenous Leukemia in First and Second Remission: Long-Term Disease-Free Survival with a Significantly Reduced Risk of Graft-versus-Host Disease. Biol Blood Marrow Transplant 2019; 26:323-332. [PMID: 31618690 DOI: 10.1016/j.bbmt.2019.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/26/2019] [Accepted: 10/05/2019] [Indexed: 01/21/2023]
Abstract
Large series of patients with acute myelogenous leukemia (AML) after ex vivo T cell-depleted (TCD) allogeneic hematopoietic stem cell transplantation (allo-HSCT) have not been reported previously. We retrospectively analyzed the outcomes of 266 patients (median age, 54 years) with AML who received CD34-selected TCD allo-HSCTs while in first (75%) or second (25%) complete remission (CR1/CR2) at a single institution. The conditioning regimens were all myeloablative, and no additional graft-versus-host disease (GVHD) prophylaxis was given. The cumulative incidences of grade II-IV and grade III-IV acute GVHD at 180 days were 14% (95% confidence interval [CI], 10% to 18%) and 3% (95% CI, 1% to 5%), respectively. The cumulative incidence of chronic GVHD at 3 years was 3% (95% CI, 1% to 6%). The 3-year cumulative incidence of nonrelapse mortality was 21% (95% CI, 16% to 26%) and that of relapse was 21% (95% CI, 17% to 27%). Overall survival (OS) and disease-free survival (DFS) at 1, 3, and 5 years were 75%, 61%, and 56% and 68%, 57%, and 53%, respectively. There were no significant differences in OS, DFS, and relapse rates for patients who underwent transplantation in CR1 and those who did so in CR2. However, patients with high-risk cytogenetics at diagnosis had significantly poorer outcomes. The OS and DFS rates compare favorably with those for unmodified allo-HSCT, but with considerably lower rates of GVHD.
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Affiliation(s)
- Juan Montoro
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Izaskun Ceberio
- Department of Hematology, Hospital Universtario Donostia, San Sebastian, Spain
| | - Patrick Hilden
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Molly A Maloy
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Juliet Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Hugo Castro-Malaspina
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Parastoo Dahi
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Guenther Koehne
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Doris Ponce
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Craig Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Brian Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Roni Tamari
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - James W Young
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Richard J O'Reilly
- Pediatric Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Ann A Jakubowski
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Esperanza B Papadopoulos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
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Alfayez M, Borthakur G. Checkpoint inhibitors and acute myelogenous leukemia: promises and challenges. Expert Rev Hematol 2019; 11:373-389. [PMID: 29589969 DOI: 10.1080/17474086.2018.1459184] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Immunity, for treatment of acute myelogenous leukemia (AML), has been leveraged historically in the form of allogeneic stem cell transplantation. Checkpoint inhibitors (CPI) as positive modulators of immune response have been recent major breakthroughs in solid tumors. Areas covered: Emerging concepts and clinical data with CPIs in acute Myeloid Leukemia - the focus of this review- will be discussed. CPIs can potentially be effective in absence of 'actionable' mutations and are expected to be effective against poor-risk AML. Immune inhibitory checkpoint molecules are upregulated in both de novo and relapsed AML. Similar data also suggest role of checkpoint molecules in mediating resistance particularly to hypomethylating agent (HMA) therapy, which can potentially be reversed by using checkpoint inhibitors. Expert commentary: Ongoing clinical trials in combination with HMAs are showing early promise, with doubling of response than that seen in historic controls. The optimal combinations of CPIs and the optimal space that they will fit in the continuum of AML therapies need lot of in depth work.
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Affiliation(s)
- Mansour Alfayez
- a Department of Leukemia , University of Texas M. D. Anderson Cancer Center , Houston , TX , USA
| | - Gautam Borthakur
- a Department of Leukemia , University of Texas M. D. Anderson Cancer Center , Houston , TX , USA
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High ETS2 expression predicts poor prognosis in acute myeloid leukemia patients undergoing allogeneic hematopoietic stem cell transplantation. Ann Hematol 2018; 98:519-525. [PMID: 30022221 DOI: 10.1007/s00277-018-3440-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
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Lim ABM, Curley C, Fong CY, Bilmon I, Beligaswatte A, Purtill D, Getta B, Johnston AM, Armytage T, Collins M, Mason K, Fielding K, Greenwood M, Gibson J, Hertzberg M, Wright M, Lewis I, Moore J, Curtis D, Szer J, Kennedy G, Ritchie D. Acute myeloid leukaemia relapsing after allogeneic haemopoietic stem cell transplantation: prognostic factors and impact of initial therapy of relapse. Intern Med J 2018. [DOI: 10.1111/imj.13522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Andrew B. M. Lim
- Department of Clinical Haematology and BMT Service; The Royal Melbourne Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
| | - Cameron Curley
- Department of Haematology and BMT; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Chun Y. Fong
- Department of Clinical Haematology; The Alfred; Melbourne Victoria Australia
| | - Ian Bilmon
- Haematology Department; St Vincent's Hospital; Sydney New South Wales Australia
- Department of Haematology; Westmead Hospital; Sydney New South Wales Australia
| | - Ashanka Beligaswatte
- Clinical Haematology Bone Marrow Transplant Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Duncan Purtill
- Department of Haematology; Royal Perth Hospital; Perth Western Australia Australia
| | - Bartlomiej Getta
- Department of Haematology; Westmead Hospital; Sydney New South Wales Australia
| | - Anne M. Johnston
- Institute of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Tasman Armytage
- Haematology Department; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Marnie Collins
- Centre for Biostatistics and Clinical Trials; Melbourne Victoria Australia
| | - Kate Mason
- Department of Clinical Haematology and BMT Service; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Katherine Fielding
- Department of Clinical Haematology and BMT Service; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Matthew Greenwood
- Haematology Department; Royal North Shore Hospital; Sydney New South Wales Australia
| | - John Gibson
- Institute of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- The University of Sydney; Sydney New South Wales Australia
| | - Mark Hertzberg
- Department of Haematology; Westmead Hospital; Sydney New South Wales Australia
| | - Matthew Wright
- Department of Haematology; Royal Perth Hospital; Perth Western Australia Australia
| | - Ian Lewis
- Clinical Haematology Bone Marrow Transplant Unit; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - John Moore
- Haematology Department; St Vincent's Hospital; Sydney New South Wales Australia
| | - David Curtis
- Department of Clinical Haematology; The Alfred; Melbourne Victoria Australia
| | - Jeff Szer
- Department of Clinical Haematology and BMT Service; The Royal Melbourne Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
| | - Glen Kennedy
- Department of Haematology and BMT; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - David Ritchie
- Department of Clinical Haematology and BMT Service; The Royal Melbourne Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
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10
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Koreth J, Antin JH, Cutler C. Allogeneic Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia and Myelodysplastic Syndrome in Adults. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00061-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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11
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Impact of Allogeneic Stem Cell Transplantation in First Complete Remission in Acute Myeloid Leukemia: A National Population-Based Cohort Study. Biol Blood Marrow Transplant 2017; 24:314-323. [PMID: 29051022 DOI: 10.1016/j.bbmt.2017.10.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 10/10/2017] [Indexed: 11/23/2022]
Abstract
To examine the outcomes of allogeneic stem cell transplantation (HSCT) in first complete remission (CR1) compared with chemotherapy alone in a population-based setting, we identified a cohort of patients with acute myeloid leukemia (AML) aged 15 to 70 years diagnosed between 2000 and 2014 in Denmark. Using the Danish National Acute Leukemia Registry, we compared relapse risk, relapse-free survival (RFS), and overall survival (OS) between patients with unfavorable cytogenetic features receiving postremission therapy with conventional chemotherapy only versus those undergoing HSCT in CR1. To minimize immortal time bias, we performed Cox proportional hazards regression, included date of allogeneic HSCT as a time-dependent covariate, and stratified the results by age (<60 or ≥60 years) and cytogenetic risk group. Overall, 1031 patients achieved a CR1. Of these, 196 patients (19%) underwent HSCT. HSCT was associated with a lower relapse rate (24% versus 49%) despite a similar median time to relapse (287 days versus 265 days). In all subgroups, the risk of relapse was lower and both RFS and OS were superior in recipients of HSCT (OS, adjusted mortality ratios: all patients, .54 [95% confidence interval (CI), .42-.71]; patients age <60 years, .58 [95% CI, .42-.81]; patients age ≥60 years, .42 [95% CI, .26-.69]; patients with intermediate-risk cytogenetics, .63 [95% CI, .43-.87]; patients with adverse-risk cytogenetics, .40 [95% CI, .24-.67]). In conclusion, in this population-based nationwide cohort study, HSCT was associated with improved survival in both younger and older patients and in patients with both intermediate and adverse cytogenetic risk.
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12
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Comont T, Tavitian S, Bardiaux L, Fort M, Debiol B, Morère D, Bérard E, Delabesse E, Luquet I, Martinez S, Huguet F, Récher C, Bertoli S. Platelet transfusion refractoriness in patients with acute myeloid leukemia treated by intensive chemotherapy. Leuk Res 2017; 61:62-67. [PMID: 28910610 DOI: 10.1016/j.leukres.2017.08.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/11/2017] [Accepted: 08/28/2017] [Indexed: 01/13/2023]
Abstract
Platelet transfusion refractoriness (PTR) is a major adverse event in the management of acute myeloid leukemia (AML). In a series of 897 adult patients with AML receiving intensive chemotherapy, we identified 41 patients (4.8%) with PTR. PTR was more frequently observed in parous women, patients with extra-medullary disease, a low white blood cell count, an infection, or hemophagocytic syndrome. Among the 31 patients with anti-human leucocyte antigen (HLA) antibodies, an HLA-matched donor was identified for 18 patients (58.1%). Median time between diagnosis of PTR and the first HLA-matched transfusion was 12.5days. HLA-matched transfusions induced a significant increment in platelet counts in 37% of cases. Thrombopoietin receptor agonists were given to 10 patients but did not shorten the duration of thrombocytopenia, reduce severe bleeding, or early death. Grade 3-4 bleeding events during induction, early death caused by bleeding, and death caused by bleeding at any time were significantly greater in patients that had platelet transfusion refractoriness (22% vs. 4.1%, P<0.0001; 12.2% vs. 1.4%, P=0.0006; and 24.4% vs. 5.3%, P<0.0001; respectively). PTR during chemotherapy for AML significantly increased the risk of early and late deaths caused by a severe bleeding event. Improved understanding of platelet destruction is needed to design mechanism-based therapeutic strategies.
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Affiliation(s)
- Thibault Comont
- Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France; Université Toulouse III Paul Sabatier, Toulouse, France
| | - Suzanne Tavitian
- Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Laurent Bardiaux
- Etablissement Français du Sang Pyrénées-Méditerranée, Toulouse, France
| | - Marylise Fort
- Laboratoire d'Immunologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Bénédicte Debiol
- Etablissement Français du Sang Pyrénées-Méditerranée, Toulouse, France
| | - Danièle Morère
- Etablissement Français du Sang Pyrénées-Méditerranée, Toulouse, France
| | - Emilie Bérard
- Service d'Epidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; UMR 1027, INSERM-Université de Toulouse III, Toulouse, France
| | - Eric Delabesse
- Université Toulouse III Paul Sabatier, Toulouse, France; Laboratoire d'Hématologie Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France; Centre de Recherches en Cancérologie de Toulouse, UMR1037-INSERM, ERL5294 CNRS, Toulouse, France
| | - Isabelle Luquet
- Université Toulouse III Paul Sabatier, Toulouse, France; Laboratoire d'Hématologie Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France; Centre de Recherches en Cancérologie de Toulouse, UMR1037-INSERM, ERL5294 CNRS, Toulouse, France
| | - Salima Martinez
- Unité d'hémovigilance, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Françoise Huguet
- Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Christian Récher
- Université Toulouse III Paul Sabatier, Toulouse, France; Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France; Centre de Recherches en Cancérologie de Toulouse, UMR1037-INSERM, ERL5294 CNRS, Toulouse, France.
| | - Sarah Bertoli
- Université Toulouse III Paul Sabatier, Toulouse, France; Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France; Centre de Recherches en Cancérologie de Toulouse, UMR1037-INSERM, ERL5294 CNRS, Toulouse, France
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13
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Canaani J, Beohou E, Labopin M, Socié G, Huynh A, Volin L, Cornelissen J, Milpied N, Gedde-Dahl T, Deconinck E, Fegueux N, Blaise D, Mohty M, Nagler A. Impact of FAB classification on predicting outcome in acute myeloid leukemia, not otherwise specified, patients undergoing allogeneic stem cell transplantation in CR1: An analysis of 1690 patients from the acute leukemia working party of EBMT. Am J Hematol 2017; 92:344-350. [PMID: 28052366 DOI: 10.1002/ajh.24640] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/15/2016] [Accepted: 01/03/2017] [Indexed: 12/13/2022]
Abstract
The French, American, and British (FAB) classification system for acute myeloid leukemia (AML) is extensively used and is incorporated into the AML, not otherwise specified (NOS) category in the 2016 WHO edition of myeloid neoplasm classification. While recent data proposes that FAB classification does not provide additional prognostic information for patients for whom NPM1 status is available, it is unknown whether FAB still retains a current prognostic role in predicting outcome of AML patients undergoing allogeneic stem cell transplantation. Using the European Society of Blood and Bone Marrow Transplantation registry we analyzed outcome of 1690 patients transplanted in CR1 to determine if FAB classification provides additional prognostic value. Multivariate analysis revealed that M6/M7 patients had decreased leukemia free survival (hazard ratio (HR) of 1.41, 95% confidence interval (CI), 1.01-1.99; P = .046) in addition to increased nonrelapse mortality (NRM) rates (HR, 1.79; 95% CI, 1.06-3.01; P = .028) compared with other FAB types. In the NPM1wt AML, NOS cohort, FAB M6/M7 was also associated with increased NRM (HR, 2.17; 95% CI, 1.14-4.16; P = .019). Finally, in FLT3-ITD+ patients, multivariate analyses revealed that specific FAB types were tightly associated with adverse outcome. In conclusion, FAB classification may predict outcome following transplantation in AML, NOS patients.
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Affiliation(s)
- Jonathan Canaani
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer; Tel Aviv University; Israel
| | - Eric Beohou
- Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Universite Pierre & Marie Curie; Paris France
- EBMT Acute Leukemia Working Party office, Hôpital Saint-Antoine; Paris France
| | - Myriam Labopin
- Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Universite Pierre & Marie Curie; Paris France
- EBMT Acute Leukemia Working Party office, Hôpital Saint-Antoine; Paris France
| | - Gerard Socié
- EBMT Acute Leukemia Working Party office, Hôpital Saint-Antoine; Paris France
| | - Anne Huynh
- Institut Universitaire du Cancer Toulouse, Oncopole; Toulouse France
| | - Liisa Volin
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit; Helsinki Finland
| | - Jan Cornelissen
- Department of Hematology; Erasmus MC Cancer Institute, University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Noel Milpied
- CHU Bordeaux, Hôpital Haut-leveque; Pessac France
| | - Tobias Gedde-Dahl
- Department of Hematology, Clinic for Cancer, Surgery and Transplantation; Oslo University Hospital, Rikshospitalet; Oslo Norway
| | - Eric Deconinck
- Service d`Hématologie; Hopital Jean Minjoz; Besancon France
| | - Nathalie Fegueux
- Département d`Hématologie Clinique; CHU Lapeyronie; Montpellier France
| | - Didier Blaise
- Centre de Recherche en Cancérologie de Marseille; Programme de Transplantation & Therapie Cellulaire; Marseille France
| | - Mohamad Mohty
- Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Universite Pierre & Marie Curie; Paris France
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer; Tel Aviv University; Israel
- EBMT Acute Leukemia Working Party office, Hôpital Saint-Antoine; Paris France
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14
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De-Mello RAB, Pinho-Vaz C, Branca R, Campilho F, Rosales M, Roncon S, Campos-Júnior A. Outcomes of allogeneic stem cell transplantation among patients with acute myeloid leukemia presenting active disease: Experience of a single European Comprehensive Cancer Center. Rev Assoc Med Bras (1992) 2016; 62:641-646. [PMID: 27925043 DOI: 10.1590/1806-9282.62.07.641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/19/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction: Allogeneic hematopoietic stem cell transplantation (ASCT) representes a potentially curative approach for patients with relapsed or refractory acute myeloid leukemia (AML). We report the outcome of relapsed/refractory AML patients treated with ASCT. Method: A retrospective cohort from 1994 to 2013 that included 61 patients with diagnosis of relapsed/refractory AML. Outcomes of interest were transplant-related mortality (TRM), incidence of acute and chronic graft-versus-host disease (GVHD), relapse incidence, progression-free survival (PFS) and overall survival (OS). Statistical significance was set at p<0.05. Results: The median age was 61 years (range 1 to 65). The cumulative incidence of 90 days, 1 year, and 3 years TRM were 60%, 26.7%, and 13.3%, respectively (p<0.001). The incidence of relapse was 21.7% at 1 year, 13% at 3 years, and 8.7% at 5 years. Median OS was estimated to be 8 months (95CI 3.266-12.734) and median PFS, 3 months (95CI 1.835-4.165). Conclusion: In our cohort, TRM in first years after ASCT remains considerable, but ASCT in this setting seems to be a good choice for AML patients with active disease. However, novel approaches are needed to reduce TRM and relapse in this set of patients.
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Affiliation(s)
- Ramon Andrade Bezerra De-Mello
- Professor of Medicine and Clinical Oncology, Instituto Português de Oncologia Francisco Gentil (IPO-Porto) and Universidade do Algarve, Faro, Portugal
| | | | | | | | - Maria Rosales
- Immune Hematology Therapist, IPO-Porto, Porto, Portugal
| | - Susana Roncon
- Immune Hematology Therapist, IPO-Porto, Porto, Portugal
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15
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Solomon SR, Sizemore CA, Zhang X, Brown S, Holland HK, Morris LE, Solh M, Bashey A. Impact of Donor Type on Outcome after Allogeneic Hematopoietic Cell Transplantation for Acute Leukemia. Biol Blood Marrow Transplant 2016; 22:1816-1822. [DOI: 10.1016/j.bbmt.2016.07.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/20/2016] [Indexed: 11/30/2022]
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16
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Tavitian S, Denis A, Vergez F, Berard E, Sarry A, Huynh A, Delabesse E, Luquet I, Huguet F, Récher C, Bertoli S. Impact of obesity in favorable-risk AML patients receiving intensive chemotherapy. Am J Hematol 2016; 91:193-8. [PMID: 26509505 DOI: 10.1002/ajh.24228] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 10/22/2015] [Accepted: 10/26/2015] [Indexed: 12/25/2022]
Abstract
We assessed the influence of obesity on the characteristics and prognosis of acute myeloid leukemia (AML). Indeed, safety of intensive chemotherapy and outcome of obese AML patients in a real-life setting are poorly described, and chemotherapy dosing remains challenging. We included 619 consecutive genetically-defined cases of AML treated with intensive chemotherapy between 2004 and 2012. In this cohort, 93 patients (15%) were classified in the obese category according to WHO classification; 59% of them received capped doses of chemotherapy because of a body surface area above 2 m(2) . Obese patients were older and presented more often with cardiovascular comorbidities. Although obese patients had more frequently de novo AML, main characteristics of AML including white blood cell count, karyotype and mutations were well-balanced between obese and non-obese patients. After induction chemotherapy, early death and complete remission rates were similar. Overall (OS), event-free (EFS) and disease-free (DFS) survival were not significantly different compared to non-obese patients. However, in the European LeukemiaNet (ELN) favorable subgroup, obese patients had lower median OS, EFS and DFS than non-obese patients (18.4, 16.8 and 17.2 vs. 43.6, 31.8 and 29.7 months, respectively) and obesity showed a significant impact on OS (OR 2.54; P = 0.02) in multivariate models. Although we did not find any significant impact of obesity on outcome in the whole series, this study suggests that special efforts for chemotherapy dose optimization are needed in the ELN favorable subgroup since dose capping may be deleterious.
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Affiliation(s)
- Suzanne Tavitian
- Service d'hématologie, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse; Toulouse France
- Université Toulouse III Paul Sabatier; Toulouse France
| | - Amélia Denis
- Cancer Research Center of Toulouse (CRCT), UMR1037 INSERM, ERL5294 CNRS; Toulouse France
- COREVIH Ile-de-France Centre, Hôpital Pitié-Salpêtrière; Paris France
| | - François Vergez
- Cancer Research Center of Toulouse (CRCT), UMR1037 INSERM, ERL5294 CNRS; Toulouse France
- Laboratoire d'hématologie, Institut Universitaire du Cancer de Toulouse Oncopole; Toulouse France
| | - Emilie Berard
- Service d'epidémiologie, Centre Hospitalier Universitaire de Toulouse; Toulouse France
- UMR 1027, INSERM-Université de Toulouse III; Toulouse France
| | - Audrey Sarry
- Service d'hématologie, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse; Toulouse France
| | - Anne Huynh
- Service d'hématologie, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse; Toulouse France
| | - Eric Delabesse
- Université Toulouse III Paul Sabatier; Toulouse France
- Cancer Research Center of Toulouse (CRCT), UMR1037 INSERM, ERL5294 CNRS; Toulouse France
- Laboratoire d'hématologie, Institut Universitaire du Cancer de Toulouse Oncopole; Toulouse France
| | - Isabelle Luquet
- Laboratoire d'hématologie, Institut Universitaire du Cancer de Toulouse Oncopole; Toulouse France
| | - Françoise Huguet
- Service d'hématologie, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse; Toulouse France
| | - Christian Récher
- Service d'hématologie, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse; Toulouse France
- Université Toulouse III Paul Sabatier; Toulouse France
- Cancer Research Center of Toulouse (CRCT), UMR1037 INSERM, ERL5294 CNRS; Toulouse France
| | - Sarah Bertoli
- Service d'hématologie, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse; Toulouse France
- Université Toulouse III Paul Sabatier; Toulouse France
- Cancer Research Center of Toulouse (CRCT), UMR1037 INSERM, ERL5294 CNRS; Toulouse France
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17
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Li D, Wang L, Zhu H, Dou L, Liu D, Fu L, Ma C, Ma X, Yao Y, Zhou L, Wang Q, Wang L, Zhao Y, Jing Y, Wang L, Li Y, Yu L. Efficacy of Allogeneic Hematopoietic Stem Cell Transplantation in Intermediate-Risk Acute Myeloid Leukemia Adult Patients in First Complete Remission: A Meta-Analysis of Prospective Studies. PLoS One 2015; 10:e0132620. [PMID: 26197471 PMCID: PMC4510363 DOI: 10.1371/journal.pone.0132620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 06/16/2015] [Indexed: 11/19/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) and consolidation chemotherapy have been used to treat intermediate-risk acute myeloid leukemia (AML) patients in first complete remission (CR1). However, it is still unclear which treatments are most effective for these patients. The aim of our study was to analyze the relapse-free survival (RFS) and overall survival (OS) benefit of allogeneic HSCT (alloHSCT) for intermediate-risk AML patients in CR1. A meta-analysis of prospective trials comparing alloHSCT to non-alloHSCT (autologous HSCT [autoHSCT] and/or chemotherapy) was undertaken. We systematically searched PubMed, Embase, and the Cochrane Library though October 2014, using keywords and relative MeSH or Emtree terms, 'allogeneic'; 'acut*' and 'leukem*/aml/leukaem*/leucem*/leucaem*'; and 'nonlympho*' or 'myelo*'. A total of 7053 articles were accessed. The primary outcomes were RFS and OS, while the secondary outcomes were treatment-related mortality (TRM) and relapse rate (RR). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated for each outcome. The primary outcomes were RFS and OS, while the secondary outcomes were TRM and RR. We included 9 prospective controlled studies including 1950 adult patients. Patients with intermediate-risk AML in CR1 who received either alloHSCT or non-alloHSCT were considered eligible. AlloHSCT was found to be associated with significantly better RFS, OS, and RR than non-alloHSCT (HR, 0.684 [95% CI: 0.48, 0.95]; HR, 0.76 [95% CI: 0.61, 0.95]; and HR, 0.58 [95% CI: 0.45, 0.75], respectively). TRM was significantly higher following alloHSCT than non-alloHSCT (HR, 3.09 [95% CI: 1.38, 6.92]). However, subgroup analysis showed no OS benefit for alloHSCT over autoHSCT (HR, 0.99 [95% CI: 0.70, 1.39]). In conclusion, alloHSCT is associated with more favorable RFS, OS, and RR benefits (but not TRM outcomes) than non-alloHSCT generally, but does not have an OS advantage over autoHSCT specifically, in patients with intermediate-risk AML in CR1.
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Affiliation(s)
- Dandan Li
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
- Medical College of Chinese PLA, Beijing, China
| | - Li Wang
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
- Medical College of Chinese PLA, Beijing, China
| | - Honghu Zhu
- Department of Hematology, Peking University People’s Hospital, Peking University Institute of Hematology, Beijing, China
| | - Liping Dou
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Daihong Liu
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Lin Fu
- Department of Hematology, Peking University Third Hospital, Beijing, China
| | - Cong Ma
- Department of clinical laboratory, PLA Navy General Hospital, Beijing, China
| | - Xuebin Ma
- Tumor diagnosis and treatment center, PLA Navy General Hospital, Beijing, China
| | - Yushi Yao
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Lei Zhou
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
- Department of Hematology, No. 202 Hospital of PLA, Shenyang, China
| | - Qian Wang
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Lijun Wang
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Yu Zhao
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Yu Jing
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Lili Wang
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Yonghui Li
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Li Yu
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
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18
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Cornelissen JJ, Versluis J, Passweg JR, van Putten WLJ, Manz MG, Maertens J, Beverloo HB, Valk PJM, van Marwijk Kooy M, Wijermans PW, Schaafsma MR, Biemond BJ, Vekemans MC, Breems DA, Verdonck LF, Fey MF, Jongen-Lavrencic M, Janssen JJWM, Huls G, Kuball J, Pabst T, Graux C, Schouten HC, Gratwohl A, Vellenga E, Ossenkoppele G, Löwenberg B. Comparative therapeutic value of post-remission approaches in patients with acute myeloid leukemia aged 40–60 years. Leukemia 2014; 29:1041-50. [DOI: 10.1038/leu.2014.332] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/06/2014] [Accepted: 11/14/2014] [Indexed: 12/27/2022]
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19
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Yanada M. Allogeneic hematopoietic cell transplantation for acute myeloid leukemia during first complete remission: a clinical perspective. Int J Hematol 2014; 101:243-54. [PMID: 25212675 DOI: 10.1007/s12185-014-1657-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/26/2014] [Accepted: 09/01/2014] [Indexed: 12/28/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is the most potent therapy for preventing relapse of acute myeloid leukemia (AML). Although its efficacy is compromised by a high risk of treatment-related morbidity and mortality, an accumulating body of evidence has led to the general recommendation favoring allogeneic HCT from a matched sibling donor during first complete remission (CR1) for younger patients with cytogenetically intermediate- or high-risk AML. Over the past few decades, this field has seen a great many advancements. The indications for allogeneic HCT have been refined by taking into account the molecular profiles of leukemic cells and the degree of comorbidities. The introduction of high-resolution human leukocyte antigen-typing technology and advances in immunosuppressive therapy and supportive care measures have improved outcomes in alternative donor transplantation, while the parallel growth of unrelated donor registries and greater use of umbilical cord blood and haploidentical donors have considerably improved the chance of finding an alternative donor. The development of reduced-intensity and non-myeloablative conditioning has made it possible to receive allogeneic HCT for patients who might once have been considered ineligible due to advanced age or comorbidities. Thanks to these advances, the role of allogeneic HCT during CR1 has become progressively more important in the treatment of AML.
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Affiliation(s)
- Masamitsu Yanada
- Department of Hematology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan,
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Isidori A, Venditti A, Maurillo L, Buccisano F, Loscocco F, Manduzio P, Sparaventi G, Amadori S, Visani G. Alternative novel therapies for the treatment of elderly acute myeloid leukemia patients. Expert Rev Hematol 2014; 6:767-84. [PMID: 24219553 DOI: 10.1586/17474086.2013.858018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
With a median age at diagnosis of approximately 65-70 years, acute myeloid leukemia (AML) represents a major therapeutic challenge in the elderly. Only 30-35% of elderly patients with AML are considered eligible for intensive chemotherapy and do actually receive it. However, the long-term benefit associated with intensive chemotherapy remains marginal, and the overall outcome for this population remains poor. The remaining 60-65% of elderly AML patients receives supportive care only. Nevertheless, several studies have indicated that patients who receive any therapy had a better outcome if compared with patients who receive supportive care only. Thus, the development of novel, less toxic, targeted agents is offering new options to older AML patients who are unfit for intensive approaches. In the present review, we will report on the results achieved using intensive chemotherapy and novel agents, and will describe some of the new strategies under development for treating older AML patients.
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Affiliation(s)
- Alessandro Isidori
- Haematology and Haematopoietic Stem Cell Transplant Center, AORMN, Marche Nord Hospital, Via Lombroso, 61100 Pesaro, Italy
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21
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Lee SJ, Storer B, Wang H, Lazarus HM, Waller EK, Isola LM, Klumpp TR, Umejiego JBC, Savani BN, Loren AW, Cairo MS, Camitta BM, Cutler CS, George B, Jean Khoury H, Marks DI, Rizzieri DA, Copelan EA, Gupta V, Liesveld JL, Litzow MR, Miller AM, Schouten HC, Gale RP, Cahn JY, Weisdorf DJ. Providing personalized prognostic information for adult leukemia survivors. Biol Blood Marrow Transplant 2013; 19:1600-7. [PMID: 24018394 DOI: 10.1016/j.bbmt.2013.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/25/2013] [Indexed: 11/30/2022]
Abstract
Prediction of subsequent leukemia-free survival (LFS) and chronic graft-versus-host disease (GVHD) in adults with acute leukemia who survived at least 1 year after allogeneic hematopoietic cell transplantation is difficult. We analyzed 3339 patients with acute myeloid leukemia and 1434 patients with acute lymphoblastic leukemia who received myeloablative conditioning and related or unrelated stem cells from 1990 to 2005. Most clinical factors predictive of LFS in 1-year survivors were no longer significant after 2 or more years. For acute myeloid leukemia, only disease status (beyond first complete remission) remained a significant adverse risk factor for LFS 2 or more years after transplantation. For lymphoblastic leukemia, only extensive chronic GVHD remained a significant adverse predictor of LFS in the second and subsequent years. For patients surviving for 1 year without disease relapse or extensive chronic GVHD, the risk of developing extensive chronic GVHD in the next year was 4% if no risk factors were present and higher if noncyclosporine-based GVHD prophylaxis, an HLA-mismatched donor, or peripheral blood stem cells were used. Estimates for subsequent LFS and extensive chronic GVHD can be derived for individual patients or populations using an online calculator (http://www.cibmtr.org/LeukemiaCalculators). This prognostic information is more relevant for survivors than estimates provided before transplantation.
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Affiliation(s)
- Stephanie J Lee
- Fred Hutchinson Cancer Research Center, Seattle, Washington.
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22
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Bayraktar UD, de Lima M, Saliba RM, Maloy M, Castro-Malaspina HR, Chen J, Rondon G, Chiattone A, Jakubowski AA, Boulad F, Kernan NA, O'Reilly RJ, Champlin RE, Giralt S, Andersson BS, Papadopoulos EB. Ex vivo T cell-depleted versus unmodified allografts in patients with acute myeloid leukemia in first complete remission. Biol Blood Marrow Transplant 2013; 19:898-903. [PMID: 23467126 DOI: 10.1016/j.bbmt.2013.02.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/23/2013] [Indexed: 10/27/2022]
Abstract
This study was conducted to retrospectively compare the clinical outcomes after transplantation of T cell-depleted (TCD) and unmodified allografts in patients with acute myeloid leukemia (AML) in first complete remission (CR1). Patients received TCD grafts at Memorial Sloan-Kettering Cancer Center (MSKCC, N = 115) between 2001 and 2010 using the following preparative regimens: hyperfractionated total body irradiation (HFTBI)+thiotepa+fludarabine; HFTBI+thiotepa+cyclophosphamide; or i.v. busulfan+melphalan+fludarabine. TCD was performed by 1 of 2 immunomagnetic CD34(+) cell selection methods for peripheral blood grafts or by soybean lectin agglutination followed by sheep red blood cell-rosette depletion for bone marrow grafts. No additional graft-versus-host disease (GVHD) prophylaxis was administered. Patients received unmodified grafts at M.D. Anderson Cancer Center (MDACC, N = 181) after conditioning with busulfan+fludarabine and GVHD prophylaxis with tacrolimus+mini-methotrexate. Patients with unrelated or human leukocyte antigen-mismatched donors received anti-thymocyte globulin (ATG) at both centers, with some recipients of matched related donor TCD transplants also receiving ATG, depending upon the preparative regimen. TCD graft recipients were more likely to be older, receive a mismatched transplant, and have peripheral blood used as the graft source. The incidences rates of grades 2 to 4 acute GVHD and chronic GVHD were significantly lower in the TCD graft group (5% versus 18%, and 13% versus 53%). Three-year relapse-free and overall survival rates were 58% and 57%, respectively, in recipients of TCD grafts, and 60% and 66% in recipients of unmodified grafts (P = not significant). Survival and relapse-free survival are similar after TCD and conventional transplants from related/unrelated donors in patients with AML in CR1, but TCD significantly reduces GVHD.
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Affiliation(s)
- Ulas D Bayraktar
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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23
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Wang Y, Liu DH, Liu KY, Xu LP, Zhang XH, Han W, Chen H, Chen YH, Huang XJ. Impact of Pretransplantation Risk Factors on Post Transplantation Outcome of Patients with Acute Myeloid Leukemia in Remission after Haploidentical Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2013; 19:283-90. [DOI: 10.1016/j.bbmt.2012.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 10/01/2012] [Indexed: 11/27/2022]
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Time from diagnosis to intensive chemotherapy initiation does not adversely impact the outcome of patients with acute myeloid leukemia. Blood 2013; 121:2618-26. [PMID: 23365464 DOI: 10.1182/blood-2012-09-454553] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
In acute myeloid leukemia (AML), new strategies assess the potential benefit of genetically targeted therapy at diagnosis. This implies waiting for laboratory tests and therefore a delay in initiation of chemotherapy. We studied the impact of time from diagnosis to treatment (TDT) on overall survival, early death, and response rate in a retrospective series of 599 newly diagnosed AML patients treated by induction chemotherapy between 2000 and 2009. The effect of TDT was assessed using multivariate analysis. TDT was analyzed as a continuous variable using a specific polynomial function to model the shape and form of the relationship. The median TDT was 8 days (interquartile range, 4-16) and was significantly longer in patients with a white blood cell count (WBC) <50 Giga per liter (G/L) (P < .0001) and in older patients (P = .0004). In multivariate analysis, TDT had no impact on overall survival (P = .4095) compared with age >60 years, secondary AML, WBC >50 G/L, European LeukemiaNet risk groups, and Eastern Cooperative Oncology Group performance status. Furthermore, TDT was not associated with response rate and early death. Thus, waiting a short period of time for laboratory tests to characterize leukemias better and design adapted therapeutic strategies at diagnosis seems possible.
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Ali N, Adil SN, Shaikh MU, Masood N. Allogeneic stem cell transplantation in acute myeloid leukemia. Hematol Rep 2012; 4:e25. [PMID: 23355943 PMCID: PMC3555213 DOI: 10.4081/hr.2012.e25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 09/11/2012] [Accepted: 11/08/2012] [Indexed: 11/25/2022] Open
Abstract
We report a case series of 12 patients with acute myeloid leukemia who underwent allogeneic stem cell transplant with a matched related donor. Male to female ratio was 1:1. The main complication post-transplant was graft-versus-host disease (n=7 patients). Transplant-related mortality involved one patient; cause of death was multi-organ failure. After a median follow up of 36.0±11.3 months, overall survival was 16%.
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Abstract
The prognostic factors in acute leukemia have undergone a major change over the past decade and are likely to be further refined in the coming years. While age is the single most important prognostic factor in both AML and in ALL, recurring cytogenetic abnormalities and molecular markers have become crucial for the prognosis of patients and for new directions in the development of targeted therapies. No less important is the development of a personalized approach for therapy as determined by the response to therapy using increasingly sensitive technologies. The assessment of MRD is rapidly superseding other prognostic factors in ALL and, somewhat lacking behind, coming into its own in AML. The next decade should see further refinement of response-driven prognostication, to include epigenetics as well as pharmacogenetics and pharmacodynamics of individual drugs used and the responses to them. It is hoped that these refinements and better predictors of response will also lead to a significantly improved overall outcome of patients with both AML and ALL.
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Affiliation(s)
- Chezi Ganzel
- Department of Hematology, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel.
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Evaluation of allogeneic hematopoietic SCT in younger adults with adverse karyotype AML. Bone Marrow Transplant 2012; 47:1436-41. [PMID: 22426749 DOI: 10.1038/bmt.2012.49] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To illustrate methodological issues, we compared donor vs no-donor to transplant vs no-transplant comparisons in a cohort of 107 patients aged 50 years with adverse karyotype AML in first CR. Adverse karyotypes were defined as -7, del(7q), -5, del(5q), t(9;22), 11q23, 3q26 or complex abnormalities. Mantel-Byar estimations and hematopoietic SCT (HSCT) as a time-dependent variable were used to compare transplant vs no-transplant cumulative incidence of relapse (CIR), relapse-free survival (RFS) and OS. In all, 52 patients had a sibling donor, but only 35 of them were transplanted in first CR, whereas 9 patients received HSCT from alternative stem cell sources. Donor-based analysis showed lower CIR in the donor group, not translating in prolonged RFS or OS. Conversely, transplant-based analysis showed that HSCT in the first CR improved the three CIR (multivariate hazard ratio (HR), 0.31; P<0.001), RFS (multivariate HR, 0.57; P=0.047) and OS (multivariate HR, 0.54; P=0.03) endpoints. At 5 years, OS was estimated at 33% in transplanted vs 18% in non-transplanted patients. The positive effect of HSCT was more pronounced in patients aged 35 years and/or in those transplanted in the more recent years. These results confirm that HSCT is likely the best curative option in younger patients with adverse karyotype AML.
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Hübel K, Weingart O, Naumann F, Bohlius J, Fresen MM, Engert A, Wheatley K. Allogeneic stem cell transplant in adult patients with acute myelogenous leukemia: a systematic analysis of international guidelines and recommendations. Leuk Lymphoma 2011; 52:444-57. [DOI: 10.3109/10428194.2010.546918] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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A Markov decision analysis of allogeneic hematopoietic cell transplantation versus chemotherapy in patients with acute myeloid leukemia in first remission. Blood 2010; 117:2113-20. [PMID: 21106987 DOI: 10.1182/blood-2010-05-285502] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Various prospective trials have been performed to assess the roles of allogeneic hematopoietic cell transplantation (allo-HCT) and chemotherapy in patients with acute myeloid leukemia (AML) in first complete remission (CR1). However, the results have not always been consistent, and there has been a limited evaluation of quality of life (QOL) in these postremission strategies. We performed a Markov decision analysis that enabled us to compare survival outcomes with a QOL evaluation using a database of 2029 adult AML patients who achieved CR1. The Markov decision model compared 2 strategies: allo-HCT or chemotherapy in CR1. Patients who had intermediate- or unfavorable-risk AML had a longer life expectancy when they received allo-HCT in CR1 than patients treated with chemotherapy alone. Likewise, patients who had a suitable related donor who received allo-HCT in CR1 had a longer life expectancy. The life expectancy was shortened to a greater degree by adjustment for QOL in the allo-HCT group. Nevertheless, QOL-adjusted life expectancies in most of the subgroups remained longer in the allo-HCT group than in the chemotherapy group. Our results showed that older patients with a related donor and younger patients with unfavorable cytogenetics benefited the most from allo-HCT in CR1.
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Allogeneic stem cell transplantation versus chemotherapy as post-remission therapy for intermediate or poor risk adult acute myeloid leukemia: results of the JALSG AML97 study. Int J Hematol 2010; 91:284-92. [PMID: 20063133 DOI: 10.1007/s12185-009-0483-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 12/04/2009] [Accepted: 12/22/2009] [Indexed: 10/20/2022]
Abstract
We prospectively compared allogeneic hematopoietic stem cell transplantation (allo-HSCT) with chemotherapy as a post-remission therapy in a multicenter trial (JALSG AML97) of adult patients with intermediate or poor risk acute myeloid leukemia (AML). Of 503 patients aged 15-50 years old registered between December 1997 and July 2001, 392 achieved complete remission (CR). CR patients classified in the intermediate or poor risk group using a new scoring system were tissue typed. Seventy-three with and 92 without an HLA-identical sibling were assigned to the donor and no-donor groups. Of 73 patients in the donor group, 38 (52%) received allo-HSCT during CR1 and 17 (23%) after relapse. Intention-to-treat analysis revealed that the relapse incidence was reduced in the donor group (52 vs. 77%; p = 0.008), and the disease-free survival (DFS) improved (39 vs. 19%; p = 0.016), but overall survival (OS) was not significantly different (46 vs. 29%; p = 0.088). The OS benefit was seen in the patients aged 36-50 years old (49 vs. 24%; p = 0.031), suggesting an advantage of allo-HSCT among older patients with leukemia that is more resistant to chemotherapy than that among younger patients.
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Hemmati PG, Terwey TH, Massenkeil G, le Coutre P, Vuong LG, Neuburger S, Dörken B, Arnold R. Reduced intensity conditioning prior to allogeneic stem cell transplantation in first complete remission is effective in patients with acute myeloid leukemia and an intermediate-risk karyotype. Int J Hematol 2010; 91:436-45. [PMID: 20180052 DOI: 10.1007/s12185-010-0515-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 01/18/2010] [Accepted: 01/24/2010] [Indexed: 01/21/2023]
Abstract
To evaluate the efficacy of reduced intensity conditioning (RIC) prior to allogeneic stem cell transplantation (alloSCT) in patients with acute myeloid leukemia (AML) in first complete remission (CR1), we retrospectively analyzed the outcome of 93 consecutive patients transplanted at our institution either following RIC (n = 37) or standard myeloablative conditioning (MAC) (n = 56) between 1999 and 2007. Projected overall survival (OS) or disease-free survival (DFS) for all patients at 1, 2, and 5 years was 78 or 70%, 65 or 57%, and 61 or 53% in the RIC group versus 73 or 70%, 68 or 62%, and 56 or 54% in the standard MAC group. In the subgroup of patients with an intermediate-risk karyotype projected OS at 1, 2, and 5 years was 86, 68, and 68% following RIC (n = 21) or 75, 69, and 66% following standard MAC (n = 36). Relapse or treatment-related mortality (TRM) was 15 or 17% (RIC group) and 26 or 14% (standard MAC group). Taken together, these data suggest that RIC-alloSCT may induce stable remissions in patients with AML transplanted in CR1. In particular, patients with an intermediate-risk karyotype ineligible to transplantation following standard MAC may benefit from RIC-alloSCT in CR1 at a low TRM.
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Affiliation(s)
- Philipp G Hemmati
- Department of Hematology and Oncology, Charité, Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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Kondo T, Yasumoto A, Arita K, Sugita JI, Shigematsu A, Okada K, Takahata M, Onozawa M, Kahata K, Takeda Y, Obara M, Yamamoto S, Endo T, Nishio M, Sato N, Tanaka J, Hashino S, Koike T, Asaka M, Imamura M. Successful treatment of acute myelogenous leukemia with favorable cytogenetics by reduced-intensity stem cell transplantation. Int J Hematol 2010; 91:310-21. [PMID: 20087795 DOI: 10.1007/s12185-009-0487-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 11/06/2009] [Accepted: 12/27/2009] [Indexed: 11/26/2022]
Abstract
Acute myelogenous leukemia (AML) with favorable cytogenetics responds well to chemotherapy. If the leukemia relapses, allogenic hematopoietic stem transplantation (allo-HSCT) is considered as a treatment option. Since the efficacy of reduced-intensity stem cell transplantation (RIST) for AML with favorable cytogenetics has not been established, we retrospectively analyzed the outcomes of allo-HSCT in AML patients according to cytogenetic risks. The outcome of allo-HSCT for AML patients with favorable cytogenetics seemed to be superior to that for AML patients with intermediate cytogenetics. In AML patients with favorable cytogenetics, the 3-year overall survival (OS) and relapse-free survival (RFS) rates were 88 and 76%, respectively, in the RIST group. Both the 3-year OS and RFS rates were 81% in the conventional stem cell transplantation (CST) group. The outcome of RIST for AML patients with favorable cytogenetics was comparable to that for patients who received CST despite the more advanced age and greater organ dysfunction in RIST group than in CST group. None of the patients died within 90 days after RIST. Moreover, there was no relapse in patients with favorable cytogenetics who were in hematological remission prior to RIST. Thus, RIST for AML patients with favorable cytogenetics in remission is safe and effective.
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Affiliation(s)
- Takeshi Kondo
- Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo 060-8648, Japan.
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Koreth J, Schlenk R, Kopecky KJ, Honda S, Sierra J, Djulbegovic BJ, Wadleigh M, DeAngelo DJ, Stone RM, Sakamaki H, Appelbaum FR, Döhner H, Antin JH, Soiffer RJ, Cutler C. Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials. JAMA 2009; 301:2349-61. [PMID: 19509382 PMCID: PMC3163846 DOI: 10.1001/jama.2009.813] [Citation(s) in RCA: 628] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CONTEXT The optimal treatment of acute myeloid leukemia (AML) in first complete remission (CR1) is uncertain. Current consensus, based on cytogenetic risk, recommends myeloablative allogeneic stem cell transplantation (SCT) for poor-risk but not for good-risk AML. Allogeneic SCT, autologous transplantation, and consolidation chemotherapy are considered of equivalent benefit for intermediate-risk AML. OBJECTIVE To quantify relapse-free survival (RFS) and overall survival benefit of allogeneic SCT for AML in CR1 overall and also for good-, intermediate-, and poor-risk AML. METHODS Systematic review and meta-analysis of prospective trials evaluating allogeneic SCT vs nonallogeneic SCT therapies for AML in CR1. The search used the combined search terms allogeneic; acut* and leukem*/leukaem*/leucem*/leucaem*/aml; myelo* or nonlympho* in the PubMed, Embase, and Cochrane Registry of Controlled Trials databases in March 2009. The search identified 1712 articles. STUDY SELECTION Prospective trials assigning adult patients with AML in CR1 to undergo allogeneic SCT vs nonallogeneic SCT treatment(s) based on donor availability and trials reporting RFS and/or overall survival outcomes on an intention-to-treat, donor vs no-donor basis were identified. DATA EXTRACTION Two reviewers independently extracted study characteristics, interventions, and outcomes. Hazard ratios (HRs) with 95% confidence intervals (CIs) were determined. DATA SYNTHESIS Overall, 24 trials and 6007 patients were analyzed (5951 patients in RFS analyses and 5606 patients in overall survival analyses); 3638 patients were analyzed by cytogenetic risk (547, 2499, and 592 with good-, intermediate-, and poor-risk AML, respectively). Interstudy heterogeneity was not significant. Fixed-effects meta-analysis was performed. Compared with nonallogeneic SCT, the HR of relapse or death with allogeneic SCT for AML in CR1 was 0.80 (95% CI, 0.74-0.86). Significant RFS benefit of allogeneic SCT was documented for poor-risk (HR, 0.69; 95% CI, 0.57-0.84) and intermediate-risk AML (HR, 0.76; 95% CI, 0.68-0.85) but not for good-risk AML (HR, 1.06; 95% CI, 0.80-1.42). The HR of death with allogeneic SCT for AML in CR1 was 0.90 (95% CI, 0.82-0.97). Significant overall survival benefit with allogeneic SCT was documented for poor-risk (HR, 0.73; 95% CI, 0.59-0.90) and intermediate-risk AML (HR, 0.83; 95% CI, 0.74-0.93) but not for good-risk AML (HR, 1.07; 95% CI, 0.83-1.38). CONCLUSION Compared with nonallogeneic SCT therapies, allogeneic SCT has significant RFS and overall survival benefit for intermediate- and poor-risk AML but not for good-risk AML in first complete remission.
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Affiliation(s)
- John Koreth
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, 44 Binney St, Boston, MA 02115
- corresponding: author , tel:+1-617-632-2949 fax:+1-617-632-5168
| | | | - Kenneth J. Kopecky
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, P.O. Box 19024, Seattle, WA 98109
| | - Sumihisa Honda
- Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Jorge Sierra
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Martha Wadleigh
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, 44 Binney St, Boston, MA 02115
| | - Daniel J. DeAngelo
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, 44 Binney St, Boston, MA 02115
| | - Richard M. Stone
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, 44 Binney St, Boston, MA 02115
| | - Hisashi Sakamaki
- Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo 113-8677, Japan
| | - Frederick R. Appelbaum
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, P.O. Box 19024, Seattle, WA 98109
| | | | - Joseph H. Antin
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, 44 Binney St, Boston, MA 02115
| | - Robert J. Soiffer
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, 44 Binney St, Boston, MA 02115
| | - Corey Cutler
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, 44 Binney St, Boston, MA 02115
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Core binding factor acute myeloid leukemia (CBF-AML): is high-dose Ara-C (HDAC) consolidation as effective as you think? Curr Opin Hematol 2009; 16:92-7. [DOI: 10.1097/moh.0b013e3283257b18] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Morra E, Barosi G, Bosi A, Ferrara F, Locatelli F, Marchetti M, Martinelli G, Mecucci C, Vignetti M, Tura S. Clinical management of primary non-acute promyelocytic leukemia acute myeloid leukemia: Practice Guidelines by the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation. Haematologica 2008; 94:102-12. [PMID: 19001282 DOI: 10.3324/haematol.13166] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
As many options are now available to treat patients with de novo acute myeloid leukemia, the Italian Society of Hematology and two affiliated societies (SIES and GITMO) commissioned project to an Expert Panel aimed at developing clinical practice guidelines for acute myeloid leukemia treatment. After systematic comprehensive literature review, the Expert Panel formulated recommendations for the management of primary acute myeloid leukemia (with the exception of acute promyelocytic leukemia) and graded them according to the supporting evidence. When evidence was lacking, consensus-based statements have been added. First-line therapy for all newly diagnosed patients eligible for intensive treatment should include one cycle of induction with standard dose cytarabine and an anthracycline. After achieving complete remission, patients aged less than 60 years should receive consolidation therapy including high-dose cytarabine. Myeloablative allogeneic stem cell transplantation from an HLA-compatible sibling should be performed in first complete remission: 1) in children with intermediate-high risk cytogenetics or who achieved first complete remission after the second course of therapy; 2) in adults less than 40 years with an intermediate-risk; in those aged less than 55 years with either high-risk cytogenetics or who achieved first complete remission after the second course of therapy. Stem cell transplantation from an unrelated donor is recommended to be performed in first complete remission in adults 30 years old or younger, and in children with very high-risk disease lacking a sibling donor. Alternative donor stem cell transplantation is an option in high-risk patients without a matched donor who urgently need transplantation. Patients aged less than 60 years, who either are not candidate for allogeneic stem cell transplantation or lack a donor, are candidates for autologous stem cell transplantation. We describe the results of a systematic literature review and an explicit approach to consensus techniques, which resulted in recommendations for the management of primary non-APL acute myeloid leukemia.
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Affiliation(s)
- Enrica Morra
- Division of Hematology, Niguarda Ca'Granda Hospital, Milan, Italy.
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36
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Allogeneic stem cell transplantation in acute myeloid leukemia: a risk-adapted approach. Blood Rev 2008; 22:293-302. [DOI: 10.1016/j.blre.2008.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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37
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Meijer E, Cornelissen JJ. Allogeneic Stem Cell Transplantation in Acute Myeloid Leukemia in First or Subsequent Remission: Weighing Prognostic Markers Predicting Relapse and Risk Factors for Non-relapse Mortality. Semin Oncol 2008; 35:449-57. [DOI: 10.1053/j.seminoncol.2008.04.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Full-intensity and reduced-intensity allogeneic stem cell transplantation in AML. Bone Marrow Transplant 2008; 41:415-23. [DOI: 10.1038/sj.bmt.1705975] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Kalaycio M, Rybicki L, Pohlman B, Dean R, Sweetenham J, Andresen S, Sobecks R, Sekeres MA, Advani A, Brown S, Bolwell B. Elevated lactate dehydrogenase is an adverse predictor of outcome in HLA-matched sibling bone marrow transplant for acute myelogenous leukemia. Bone Marrow Transplant 2007; 40:753-8. [PMID: 17700600 DOI: 10.1038/sj.bmt.1705811] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prognostic factors for survival following allogeneic BMT for AML include age, disease status and cytogenetic risk classification. Lactate dehydrogenase (LDH) levels have not been studied as a potential risk factor. We reviewed our experience with BMT for AML and included LDH at the time of admission in an analysis of prognostic factors for survival. We found that LDH >330 U/l (1.5 times the upper limit of normal at our institution), older age, active disease, peripheral stem cell graft and male-to-male transplant were significant adverse predictors of survival. After accounting for LDH, other factors such as disease status and cytogenetics were not significantly associated with the outcome of BMT. All but one patient with an LDH >330 U/l had active disease. However, when patients in CR were excluded, LDH >330 U/l remained a significant adverse predictor of overall survival (hazard ratio 2.70, 95% confidence interval 1.41-5.16, P=0.003). We conclude that LDH is an important adverse risk factor for survival and should be included in future studies of risk performed on larger patient cohorts.
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Affiliation(s)
- M Kalaycio
- Department of Hematologic Oncology and Blood Disorders, The Cleveland Clinic, Taussig Cancer Center, Cleveland, OH 44195, USA.
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Abstract
The median age of patients with acute myeloid leukemia (AML) is 65 to 70 years. The majority of older patients with AML probably do not receive specific treatment, and those who receive standard regimens have a median survival time of less than 1 year. This suggests that, in general, older patients should receive investigational therapy; however, factors other than age influence survival after administration of standard treatment and need to be accounted for when making treatment recommendations. In some cases where investigational therapy is unavailable, palliative care may be the best option. Like AML, myelodysplastic syndrome (MDS) is a disease of the elderly. It is divided into higher and lower risk groups. The natural history of high-risk MDS (eg, > 10% marrow blasts) bears more resemblance to that of AML than to that of an indolent disorder; accordingly, similar therapeutic considerations apply. The more benign natural history of lower risk MDS leads to consideration of reduction in transfusion needs and improvement in quality of life as primary goals of therapy. Lenalidomide, azacitidine, and decitabine, each recently approved by the US Food and Drug Administration, are useful in achieving these objectives.
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Affiliation(s)
- Elihu Estey
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Cornelissen JJ, van Putten WLJ, Verdonck LF, Theobald M, Jacky E, Daenen SMG, van Marwijk Kooy M, Wijermans P, Schouten H, Huijgens PC, van der Lelie H, Fey M, Ferrant A, Maertens J, Gratwohl A, Lowenberg B. Results of a HOVON/SAKK donor versus no-donor analysis of myeloablative HLA-identical sibling stem cell transplantation in first remission acute myeloid leukemia in young and middle-aged adults: benefits for whom? Blood 2007; 109:3658-66. [PMID: 17213292 DOI: 10.1182/blood-2006-06-025627] [Citation(s) in RCA: 362] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The Dutch-Belgian Hemato-Oncology Cooperative Group and the Swiss Group for Clinical Cancer Research (HOVON-SAKK) collaborative study group evaluated outcome of patients (pts) with acute myeloid leukemia (AML) in first remission (CR1) entered in 3 consecutive studies according to a donor versus no-donor comparison. Between 1987 and 2004, 2287 pts were entered in these studies of whom 1032 pts (45%) without FAB M3 or t(15;17) were in CR1 after 2 cycles of chemotherapy, received consolidation treatment, and were younger than 55 years of age and therefore eligible for allogeneic hematopoietic stem cell transplantation (allo-SCT). An HLA-identical sibling donor was available for 326 pts (32%), whereas 599 pts (58%) lacked such a donor, and information was not available in 107 pts. Compliance with allo-SCT was 82% (268 of 326). Cumulative incidences of relapse were, respectively, 32% versus 59% for pts with versus those without a donor (P < .001). Despite more treatment-related mortality (TRM) in the donor group (21% versus 4%, P < .001), disease-free survival (DFS) appeared significantly better in the donor group (48% +/- 3% versus 37% +/- 2% in the no-donor group, P < .001). Following risk-group analysis, DFS was significantly better for pts with a donor and an intermediate- (P = .01) or poor-risk profile (P = .003) and also better in pts younger than 40 years of age (P < .001). We evaluated our results and those of the previous MRC, BGMT, and EORTC studies in a meta-analysis, which revealed a significant benefit of 12% in overall survival (OS) by donor availability for all patients with AML in CR1 without a favorable cytogenetic profile.
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Affiliation(s)
- Jan J Cornelissen
- Department of Hematology, Erasmus University Medical Center, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands.
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Boissel N, Leroy H, Brethon B, Philippe N, de Botton S, Auvrignon A, Raffoux E, Leblanc T, Thomas X, Hermine O, Quesnel B, Baruchel A, Leverger G, Dombret H, Preudhomme C. Incidence and prognostic impact of c-Kit, FLT3, and Ras gene mutations in core binding factor acute myeloid leukemia (CBF-AML). Leukemia 2006; 20:965-70. [PMID: 16598313 DOI: 10.1038/sj.leu.2404188] [Citation(s) in RCA: 269] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In core binding factors (CBF) acute myeloid leukemia (AML), the disruption of CBFalpha/beta genes impairs normal hematopoietic differentiation and is supposed to cooperate with additional mutations promoting proliferation. The incidence and the prognosis of receptor tyrosine kinase (RTK) c-Kit and FLT3 mutations and Ras mutations were evaluated in 103 pediatric and adult patients with CBF-AML. c-Kit mutations were present in 17% patients. c-Kit exon 8 mutations were more frequent in inv(16) than in t(8;21) subset (20 versus 6%). Only one patient had FLT3-ITD but FLT3-D835 was as frequent as reported in AML population (7%). Ras mutations were significantly more frequent in inv(16) than in t(8;21) subset (36 versus 8%, P=0.001). RTK mutations were associated with a higher white blood cell count (WBC) (36 versus 21 G/L, P=0.05). FLT3 mutations were significantly associated with a shorter EFS and survival (P<0.0001 and P=0.0002) owing to an excess of early events. c-Kit mutations were associated with a shorter EFS and RFS (P=0.002 and P=0.003) in t(8;21) but not inv(16) patients. As previously observed, Ras mutations did not affect prognosis. Screening for RTK mutations may help to identify patients with a more adverse outcome and thus susceptible to benefit from intensified protocols or RTK inhibitors.
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Affiliation(s)
- N Boissel
- Service d'Hématologie Adulte, Hôpital Saint-Louis, Paris, France
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Current Awareness in Hematological Oncology. Hematol Oncol 2006. [DOI: 10.1002/hon.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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