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Socie G, Galimard JE, Raffoux E, Itzykson R, Debureaux PE, Michonneau D, Lengliné E, Robin M, De Fontbrune FS, Sébert M, Xhaard A, Kim R, Couprie A, Dhedin N, Dragani M, Lemaire P, Larcher L, Clappier E, Boissel N, Soulier J, Dombret H, Fenaux P, De Latour RP, Adès L. Allogeneic transplantation in acute myelogenous leukemia: a comprehensive single institution's experience. Haematologica 2023; 108:2369-2379. [PMID: 36951151 PMCID: PMC10483356 DOI: 10.3324/haematol.2023.282729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023] Open
Abstract
Debates on the role and timing of allogeneic hemtopoietic stem cell transplantation (HSCT) in acute myelogenous leukemia (AML) have persisted for decades. Time to transplant introduces an immortal time and current treatment algorithm mainly relies on the European LeukemiaNet disease risk classification. Previous studies are also limited to age groups, remission status and other ill-defined parameters. We studied all patients at diagnosis irrespective of age and comorbidities to estimate the cumulative incidence and potential benefit or disadvantage of HSCT in a single center. As a time-dependent covariate, HSCT improved overall survival in intermediate- and poor-risk patients (hazard ratio =0.51; P=0.004). In goodrisk patients only eight were transplanted in first complete remission. Overall, the 4-year cumulative incidence of HSCT was only 21.9% but was higher (52.1%) for patients in the first age quartile (16-57 years old) and 26.4% in older patients (57-70 years old) (P<0.001). It was negligible in patients older than 70 years reflecting our own transplant policy but also barriers to transplantation (comorbidities and remission status). However, HSCT patients need to survive, be considered eligible both by the referring and the HSCT physicians and have a suitable donor to get transplantation. We, thus, comprehensively analyzed the complete decision-making and outcome of all our AML patients from diagnosis to last followup to decipher how patient allocation and therapy inform the value of HSCT. The role of HSCT in AML is shifting with broad access to different donors including haploidentical ones. Thus, it may (or may not) lead to increased numbers of allogeneic HSCT in AML in adults.
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Affiliation(s)
- Gerard Socie
- Université Paris Cité APHP, Hématologie Greffe, Hôpital Saint Louis; INSERM UMR 976, Hôpital Saint Louis.
| | | | - Emmanuel Raffoux
- Université Paris Cité APHP, Hématologie Adultes, Hôpital Saint Louis
| | - Raphael Itzykson
- Université Paris Cité APHP, Hématologie Adultes, Hôpital Saint Louis
| | | | - David Michonneau
- Université Paris Cité APHP, Hématologie Greffe, Hôpital Saint Louis; INSERM UMR 976, Hôpital Saint Louis
| | | | - Marie Robin
- APHP, Hématologie Greffe, Hôpital Saint Louis
| | | | | | | | - Rathana Kim
- APHP, Hématologie Séniors, Hôpital Saint Louis
| | | | - Nathalie Dhedin
- APHP, Hématologie Adolescents Jeunes Adultes, Hôpital Saint Louis
| | | | | | - Lise Larcher
- Université Paris Cité APHP, Laboratoire d'Hématologie, Hôpital Saint Louis
| | | | - Nicolas Boissel
- Université Paris Cité APHP, Hématologie Adolescents Jeunes Adultes, Hôpital Saint Louis
| | - Jean Soulier
- Université Paris Cité APHP, Laboratoire d'Hématologie, Hôpital Saint Louis
| | - Hervé Dombret
- Université Paris Cité APHP, Hématologie Adultes, Hôpital Saint Louis
| | - Pierre Fenaux
- Université Paris Cité APHP, Hématologie Séniors, Hôpital Saint Louis
| | | | - Lionel Adès
- Université Paris Cité APHP, Hématologie Séniors, Hôpital Saint Louis
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Pouchot J, Couprie A. A wandering spleen, splenomegaly, hypersplenism, and iron deficiency anaemia. Lancet 2020; 396:412. [PMID: 32771108 DOI: 10.1016/s0140-6736(20)31552-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/11/2020] [Accepted: 07/01/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Jacques Pouchot
- Hôpital européen Georges-Pompidou, Médecine Interne, Assistance Publique, Hôpitaux de Paris, Paris, France.
| | - Anne Couprie
- Hôpital européen Georges-Pompidou, Médecine Interne, Assistance Publique, Hôpitaux de Paris, Paris, France
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