CLINICAL OUTCOME AND EFFECT OF ALLO-SCT IN ADULT PATIENTS WITH DE NOVO OR AML-RELATED MYELOID SARCOMA. RESULTS FROM AN ITALIAN MULTICENTER SURVEY.
(Abstract release date: 05/19/16)
EHA Library. Lazzarotto D. 06/09/16; 132461; E912
Dr. Davide Lazzarotto
Contributions
Contributions
Abstract
Abstract: E912
Type: Eposter Presentation
Background
Myeloid Sarcoma (MS) is a rare hematologic myeloid neoplasm that can involve any site of the body. It can occur as isolated “de novo” extramedullary form or it can be associated with an acute myeloid leukemia (AML), a chronic myeloproliferative neoplasm (MPN) or a myelodysplastic syndrome (MDS) at onset or at relapse (secondary MS).
Aims
The rarity of MS does not enable prospective clinical trials and therefore a specific multicenter register can be very useful for the clinical and biological studies of this rare disease.
Methods
We report the clinical characteristics and outcome of 53 histologically confirmed MS, diagnosed and treated in 9 Italian Hematological Centers in the last 10 years (2005-2015).
Results
The median age of these patients (pts) was 47 years (range 15-82) and 30 (56.6%) were male. There were 9/53 de novo extramedullary MS, 24/53 primary AML-related MS and 20/53 were secondary MS (the median time to the onset of MS from the previous haematologic disease was 34.5 months, range 4–94). Histologic and biologic data are available in all cases. The most common extramedullary anatomic sites of disease were: skin, lymph nodes, soft tissues, bone and testis. Treatment: 46/53 pts (86.8%) underwent a program of intensive chemotherapy (combined with radiotherapy in 16/46 cases) including FLAI, HDAC-IDA, HyperCVAD and MEC schemes, with a CR Rate of 43.5% (20/46). Twenty-four (52.2%) pts underwent Allo-SCT, 9 from an HLA-identical sibling donor, 2 from an haploidentical donor and 13 from a MUD. The median OS of the whole population (53 pts) was 16.7 months with no differences between de novo extramedullary MS and AML-related MS (p=0.71). The OS probability at 5 yrs was 33,8%. The survival was significantly better in the pts that underwent an intensive therapeutic program (median OS: 18.3 mths vs 5.4 mths, P=0,006). Furthermore, among the intensively treated pts, the survival was better in those pts that underwent Allo-SCT (median OS not reached vs 10.6 mths, P=0,001), in pts with de novo or primary MS (median OS 20.4 mths vs 10.6 mths of the secondary MS, P=0,012) and in the pts that achieved a CR after induction chemotherapy (median OS not reached vs 14.6 mths, P=0,07) without differences between de novo extramedullary MS and AML-related MS (p=0.76). In multivariate analysis, Allo-SCT and Response to Induction therapy, were the only significant variables in predicting survival (P=0,002 and P=0,037, respectively). The median post-transplant OS of the Allo-SCT recipients was not reached after a median follow-up of 17.5 months and we observe a survival advantage in the patients who achieved a pre-transplant CR (P=0,042) and in the patients who developed a chronic GvHD after Allo-SCT (P=0,065).
Conclusion
The pts with isolated MS result to have a similar unfavourable outcome than the patients with AML-related MS. These data outline the need of underwent an intensive therapeutic program that includes Allo-SCT, whenever possible, both in isolated extramedullary MS and in AML-related MS. The outcome after Allo-SCT is positively influenced by the development of chronic GvHD suggesting a Graft versus MS effect.
Session topic: E-poster
Keyword(s): Allogeneic hematopoietic stem cell transplant, Myeloid malignancies
Type: Eposter Presentation
Background
Myeloid Sarcoma (MS) is a rare hematologic myeloid neoplasm that can involve any site of the body. It can occur as isolated “de novo” extramedullary form or it can be associated with an acute myeloid leukemia (AML), a chronic myeloproliferative neoplasm (MPN) or a myelodysplastic syndrome (MDS) at onset or at relapse (secondary MS).
Aims
The rarity of MS does not enable prospective clinical trials and therefore a specific multicenter register can be very useful for the clinical and biological studies of this rare disease.
Methods
We report the clinical characteristics and outcome of 53 histologically confirmed MS, diagnosed and treated in 9 Italian Hematological Centers in the last 10 years (2005-2015).
Results
The median age of these patients (pts) was 47 years (range 15-82) and 30 (56.6%) were male. There were 9/53 de novo extramedullary MS, 24/53 primary AML-related MS and 20/53 were secondary MS (the median time to the onset of MS from the previous haematologic disease was 34.5 months, range 4–94). Histologic and biologic data are available in all cases. The most common extramedullary anatomic sites of disease were: skin, lymph nodes, soft tissues, bone and testis. Treatment: 46/53 pts (86.8%) underwent a program of intensive chemotherapy (combined with radiotherapy in 16/46 cases) including FLAI, HDAC-IDA, HyperCVAD and MEC schemes, with a CR Rate of 43.5% (20/46). Twenty-four (52.2%) pts underwent Allo-SCT, 9 from an HLA-identical sibling donor, 2 from an haploidentical donor and 13 from a MUD. The median OS of the whole population (53 pts) was 16.7 months with no differences between de novo extramedullary MS and AML-related MS (p=0.71). The OS probability at 5 yrs was 33,8%. The survival was significantly better in the pts that underwent an intensive therapeutic program (median OS: 18.3 mths vs 5.4 mths, P=0,006). Furthermore, among the intensively treated pts, the survival was better in those pts that underwent Allo-SCT (median OS not reached vs 10.6 mths, P=0,001), in pts with de novo or primary MS (median OS 20.4 mths vs 10.6 mths of the secondary MS, P=0,012) and in the pts that achieved a CR after induction chemotherapy (median OS not reached vs 14.6 mths, P=0,07) without differences between de novo extramedullary MS and AML-related MS (p=0.76). In multivariate analysis, Allo-SCT and Response to Induction therapy, were the only significant variables in predicting survival (P=0,002 and P=0,037, respectively). The median post-transplant OS of the Allo-SCT recipients was not reached after a median follow-up of 17.5 months and we observe a survival advantage in the patients who achieved a pre-transplant CR (P=0,042) and in the patients who developed a chronic GvHD after Allo-SCT (P=0,065).
Conclusion
The pts with isolated MS result to have a similar unfavourable outcome than the patients with AML-related MS. These data outline the need of underwent an intensive therapeutic program that includes Allo-SCT, whenever possible, both in isolated extramedullary MS and in AML-related MS. The outcome after Allo-SCT is positively influenced by the development of chronic GvHD suggesting a Graft versus MS effect.
Session topic: E-poster
Keyword(s): Allogeneic hematopoietic stem cell transplant, Myeloid malignancies
Abstract: E912
Type: Eposter Presentation
Background
Myeloid Sarcoma (MS) is a rare hematologic myeloid neoplasm that can involve any site of the body. It can occur as isolated “de novo” extramedullary form or it can be associated with an acute myeloid leukemia (AML), a chronic myeloproliferative neoplasm (MPN) or a myelodysplastic syndrome (MDS) at onset or at relapse (secondary MS).
Aims
The rarity of MS does not enable prospective clinical trials and therefore a specific multicenter register can be very useful for the clinical and biological studies of this rare disease.
Methods
We report the clinical characteristics and outcome of 53 histologically confirmed MS, diagnosed and treated in 9 Italian Hematological Centers in the last 10 years (2005-2015).
Results
The median age of these patients (pts) was 47 years (range 15-82) and 30 (56.6%) were male. There were 9/53 de novo extramedullary MS, 24/53 primary AML-related MS and 20/53 were secondary MS (the median time to the onset of MS from the previous haematologic disease was 34.5 months, range 4–94). Histologic and biologic data are available in all cases. The most common extramedullary anatomic sites of disease were: skin, lymph nodes, soft tissues, bone and testis. Treatment: 46/53 pts (86.8%) underwent a program of intensive chemotherapy (combined with radiotherapy in 16/46 cases) including FLAI, HDAC-IDA, HyperCVAD and MEC schemes, with a CR Rate of 43.5% (20/46). Twenty-four (52.2%) pts underwent Allo-SCT, 9 from an HLA-identical sibling donor, 2 from an haploidentical donor and 13 from a MUD. The median OS of the whole population (53 pts) was 16.7 months with no differences between de novo extramedullary MS and AML-related MS (p=0.71). The OS probability at 5 yrs was 33,8%. The survival was significantly better in the pts that underwent an intensive therapeutic program (median OS: 18.3 mths vs 5.4 mths, P=0,006). Furthermore, among the intensively treated pts, the survival was better in those pts that underwent Allo-SCT (median OS not reached vs 10.6 mths, P=0,001), in pts with de novo or primary MS (median OS 20.4 mths vs 10.6 mths of the secondary MS, P=0,012) and in the pts that achieved a CR after induction chemotherapy (median OS not reached vs 14.6 mths, P=0,07) without differences between de novo extramedullary MS and AML-related MS (p=0.76). In multivariate analysis, Allo-SCT and Response to Induction therapy, were the only significant variables in predicting survival (P=0,002 and P=0,037, respectively). The median post-transplant OS of the Allo-SCT recipients was not reached after a median follow-up of 17.5 months and we observe a survival advantage in the patients who achieved a pre-transplant CR (P=0,042) and in the patients who developed a chronic GvHD after Allo-SCT (P=0,065).
Conclusion
The pts with isolated MS result to have a similar unfavourable outcome than the patients with AML-related MS. These data outline the need of underwent an intensive therapeutic program that includes Allo-SCT, whenever possible, both in isolated extramedullary MS and in AML-related MS. The outcome after Allo-SCT is positively influenced by the development of chronic GvHD suggesting a Graft versus MS effect.
Session topic: E-poster
Keyword(s): Allogeneic hematopoietic stem cell transplant, Myeloid malignancies
Type: Eposter Presentation
Background
Myeloid Sarcoma (MS) is a rare hematologic myeloid neoplasm that can involve any site of the body. It can occur as isolated “de novo” extramedullary form or it can be associated with an acute myeloid leukemia (AML), a chronic myeloproliferative neoplasm (MPN) or a myelodysplastic syndrome (MDS) at onset or at relapse (secondary MS).
Aims
The rarity of MS does not enable prospective clinical trials and therefore a specific multicenter register can be very useful for the clinical and biological studies of this rare disease.
Methods
We report the clinical characteristics and outcome of 53 histologically confirmed MS, diagnosed and treated in 9 Italian Hematological Centers in the last 10 years (2005-2015).
Results
The median age of these patients (pts) was 47 years (range 15-82) and 30 (56.6%) were male. There were 9/53 de novo extramedullary MS, 24/53 primary AML-related MS and 20/53 were secondary MS (the median time to the onset of MS from the previous haematologic disease was 34.5 months, range 4–94). Histologic and biologic data are available in all cases. The most common extramedullary anatomic sites of disease were: skin, lymph nodes, soft tissues, bone and testis. Treatment: 46/53 pts (86.8%) underwent a program of intensive chemotherapy (combined with radiotherapy in 16/46 cases) including FLAI, HDAC-IDA, HyperCVAD and MEC schemes, with a CR Rate of 43.5% (20/46). Twenty-four (52.2%) pts underwent Allo-SCT, 9 from an HLA-identical sibling donor, 2 from an haploidentical donor and 13 from a MUD. The median OS of the whole population (53 pts) was 16.7 months with no differences between de novo extramedullary MS and AML-related MS (p=0.71). The OS probability at 5 yrs was 33,8%. The survival was significantly better in the pts that underwent an intensive therapeutic program (median OS: 18.3 mths vs 5.4 mths, P=0,006). Furthermore, among the intensively treated pts, the survival was better in those pts that underwent Allo-SCT (median OS not reached vs 10.6 mths, P=0,001), in pts with de novo or primary MS (median OS 20.4 mths vs 10.6 mths of the secondary MS, P=0,012) and in the pts that achieved a CR after induction chemotherapy (median OS not reached vs 14.6 mths, P=0,07) without differences between de novo extramedullary MS and AML-related MS (p=0.76). In multivariate analysis, Allo-SCT and Response to Induction therapy, were the only significant variables in predicting survival (P=0,002 and P=0,037, respectively). The median post-transplant OS of the Allo-SCT recipients was not reached after a median follow-up of 17.5 months and we observe a survival advantage in the patients who achieved a pre-transplant CR (P=0,042) and in the patients who developed a chronic GvHD after Allo-SCT (P=0,065).
Conclusion
The pts with isolated MS result to have a similar unfavourable outcome than the patients with AML-related MS. These data outline the need of underwent an intensive therapeutic program that includes Allo-SCT, whenever possible, both in isolated extramedullary MS and in AML-related MS. The outcome after Allo-SCT is positively influenced by the development of chronic GvHD suggesting a Graft versus MS effect.
Session topic: E-poster
Keyword(s): Allogeneic hematopoietic stem cell transplant, Myeloid malignancies
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