PREDICTIVE FACTORS FOR RELAPSE IN PATIENTS WITH ACUTE MYELOID LEUKEMIA SUBMITTED TO ALLOGENEIC STEM CELL TRANSPLANTATION: A SINGLE CENTER EXPERIENCE
(Abstract release date: 05/19/16)
EHA Library. Pastore D. 06/09/16; 135089; PB2189
Dr. Domenico Pastore
Contributions
Contributions
Abstract
Abstract: PB2189
Type: Publication Only
Background
Adults with high risk acute myeloid leukemia features at diagnosis, primary induction failure (PIF) or with recurrent disease have a poor outcome after chemotherapy and are candidates for allogeneic stem cell transplantation (allo SCT). However, the relapse rate in these patients remains a matter of concern.
Aims
Aim of the study is to identify the main factors influencing acute myeloid leukemia (AML) relapse after allo SCT in a single center.
Methods
118 adult AML patients (median age 42 y [range 16-68], 50 M/ 68 F) received an alloSCT at our Institution from 2000 to 2015. Donors for HCT were HLA-matched related donors in 68/118 (57%) and “alternative donors” (matched unrelated or haploidentical donors) in 50/118 (43%) transplantations. The source of hematopoietic stem cells was peripheral blood in 110/118 (93%) and bone marrow in 8/118(7%) patients; 90 % patients underwent a myeloablative conditioning regimen and 10 % a reduced intensity regimen. Disease status (1st CR versus not[2nd/3nd CR and “active disease”]), molecular-cytogenetic risk(intermediate versus poor-risk), response to first chemotherapy( responders versus primary induction failure/PIF), time from diagnosis to transplantation (more or less than 6 months), stem cell source (bone marrow or peripheral blood), donor type (matched related or alternative), severe acute GvHD (grade IIII-IV), chronic GvHD, serological risk CMV status were analyzed as predisposing factors for relapse. Multivariate analysis was performed with the variables identified as relevant at univariate analysis.
Results
Transplantation for AML was done in 1st CR in 53/118 (44%) patients and not in 1st CR in 65/118 (56%) patients. Thirty-nine patients (33%) were PIF and 83/118 (70%) transplants were done within 6 months from diagnosis; 28/118(23%)patients were classified as poor molecular-cytogenetic risk. Twenty-six (18%) suffered GvHD grade III-IV and 32%, 15% and 8% of evaluable patients developed limited, moderate and severe cGvHD. The 2-year relapse incidence was 55%: 36 % for patients in CR1 and 75% for patients not in CR1(p=0.001). At multivariate analysis the disease status (1st CR)(p=0.02 HR 0.73, 95%CI 1.0-2.8) and cGvHD(p=0.001 HR 0.2, 95%CI 0.1-0.4) were the factors associated with a lower relapse incidence. Donor type, molecular-cytogenetic risk, response to first chemotherapy, stem cell source, acute GvHD did not seem to significantly influence relapse.
Conclusion
In our experience allogeneic transplants performed in 1stCR and cGvHD were the main factors influencing the risk of relapse in adult patients with AML. Transplanted patients not in 1st CR and without cGvHD may be a “high relapse risk group” that could benefit from pre-emptive therapy post transplantation also with new drugs.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Relapsed acute myeloid leukemia, Stem cell transplant
Type: Publication Only
Background
Adults with high risk acute myeloid leukemia features at diagnosis, primary induction failure (PIF) or with recurrent disease have a poor outcome after chemotherapy and are candidates for allogeneic stem cell transplantation (allo SCT). However, the relapse rate in these patients remains a matter of concern.
Aims
Aim of the study is to identify the main factors influencing acute myeloid leukemia (AML) relapse after allo SCT in a single center.
Methods
118 adult AML patients (median age 42 y [range 16-68], 50 M/ 68 F) received an alloSCT at our Institution from 2000 to 2015. Donors for HCT were HLA-matched related donors in 68/118 (57%) and “alternative donors” (matched unrelated or haploidentical donors) in 50/118 (43%) transplantations. The source of hematopoietic stem cells was peripheral blood in 110/118 (93%) and bone marrow in 8/118(7%) patients; 90 % patients underwent a myeloablative conditioning regimen and 10 % a reduced intensity regimen. Disease status (1st CR versus not[2nd/3nd CR and “active disease”]), molecular-cytogenetic risk(intermediate versus poor-risk), response to first chemotherapy( responders versus primary induction failure/PIF), time from diagnosis to transplantation (more or less than 6 months), stem cell source (bone marrow or peripheral blood), donor type (matched related or alternative), severe acute GvHD (grade IIII-IV), chronic GvHD, serological risk CMV status were analyzed as predisposing factors for relapse. Multivariate analysis was performed with the variables identified as relevant at univariate analysis.
Results
Transplantation for AML was done in 1st CR in 53/118 (44%) patients and not in 1st CR in 65/118 (56%) patients. Thirty-nine patients (33%) were PIF and 83/118 (70%) transplants were done within 6 months from diagnosis; 28/118(23%)patients were classified as poor molecular-cytogenetic risk. Twenty-six (18%) suffered GvHD grade III-IV and 32%, 15% and 8% of evaluable patients developed limited, moderate and severe cGvHD. The 2-year relapse incidence was 55%: 36 % for patients in CR1 and 75% for patients not in CR1(p=0.001). At multivariate analysis the disease status (1st CR)(p=0.02 HR 0.73, 95%CI 1.0-2.8) and cGvHD(p=0.001 HR 0.2, 95%CI 0.1-0.4) were the factors associated with a lower relapse incidence. Donor type, molecular-cytogenetic risk, response to first chemotherapy, stem cell source, acute GvHD did not seem to significantly influence relapse.
Conclusion
In our experience allogeneic transplants performed in 1stCR and cGvHD were the main factors influencing the risk of relapse in adult patients with AML. Transplanted patients not in 1st CR and without cGvHD may be a “high relapse risk group” that could benefit from pre-emptive therapy post transplantation also with new drugs.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Relapsed acute myeloid leukemia, Stem cell transplant
Abstract: PB2189
Type: Publication Only
Background
Adults with high risk acute myeloid leukemia features at diagnosis, primary induction failure (PIF) or with recurrent disease have a poor outcome after chemotherapy and are candidates for allogeneic stem cell transplantation (allo SCT). However, the relapse rate in these patients remains a matter of concern.
Aims
Aim of the study is to identify the main factors influencing acute myeloid leukemia (AML) relapse after allo SCT in a single center.
Methods
118 adult AML patients (median age 42 y [range 16-68], 50 M/ 68 F) received an alloSCT at our Institution from 2000 to 2015. Donors for HCT were HLA-matched related donors in 68/118 (57%) and “alternative donors” (matched unrelated or haploidentical donors) in 50/118 (43%) transplantations. The source of hematopoietic stem cells was peripheral blood in 110/118 (93%) and bone marrow in 8/118(7%) patients; 90 % patients underwent a myeloablative conditioning regimen and 10 % a reduced intensity regimen. Disease status (1st CR versus not[2nd/3nd CR and “active disease”]), molecular-cytogenetic risk(intermediate versus poor-risk), response to first chemotherapy( responders versus primary induction failure/PIF), time from diagnosis to transplantation (more or less than 6 months), stem cell source (bone marrow or peripheral blood), donor type (matched related or alternative), severe acute GvHD (grade IIII-IV), chronic GvHD, serological risk CMV status were analyzed as predisposing factors for relapse. Multivariate analysis was performed with the variables identified as relevant at univariate analysis.
Results
Transplantation for AML was done in 1st CR in 53/118 (44%) patients and not in 1st CR in 65/118 (56%) patients. Thirty-nine patients (33%) were PIF and 83/118 (70%) transplants were done within 6 months from diagnosis; 28/118(23%)patients were classified as poor molecular-cytogenetic risk. Twenty-six (18%) suffered GvHD grade III-IV and 32%, 15% and 8% of evaluable patients developed limited, moderate and severe cGvHD. The 2-year relapse incidence was 55%: 36 % for patients in CR1 and 75% for patients not in CR1(p=0.001). At multivariate analysis the disease status (1st CR)(p=0.02 HR 0.73, 95%CI 1.0-2.8) and cGvHD(p=0.001 HR 0.2, 95%CI 0.1-0.4) were the factors associated with a lower relapse incidence. Donor type, molecular-cytogenetic risk, response to first chemotherapy, stem cell source, acute GvHD did not seem to significantly influence relapse.
Conclusion
In our experience allogeneic transplants performed in 1stCR and cGvHD were the main factors influencing the risk of relapse in adult patients with AML. Transplanted patients not in 1st CR and without cGvHD may be a “high relapse risk group” that could benefit from pre-emptive therapy post transplantation also with new drugs.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Relapsed acute myeloid leukemia, Stem cell transplant
Type: Publication Only
Background
Adults with high risk acute myeloid leukemia features at diagnosis, primary induction failure (PIF) or with recurrent disease have a poor outcome after chemotherapy and are candidates for allogeneic stem cell transplantation (allo SCT). However, the relapse rate in these patients remains a matter of concern.
Aims
Aim of the study is to identify the main factors influencing acute myeloid leukemia (AML) relapse after allo SCT in a single center.
Methods
118 adult AML patients (median age 42 y [range 16-68], 50 M/ 68 F) received an alloSCT at our Institution from 2000 to 2015. Donors for HCT were HLA-matched related donors in 68/118 (57%) and “alternative donors” (matched unrelated or haploidentical donors) in 50/118 (43%) transplantations. The source of hematopoietic stem cells was peripheral blood in 110/118 (93%) and bone marrow in 8/118(7%) patients; 90 % patients underwent a myeloablative conditioning regimen and 10 % a reduced intensity regimen. Disease status (1st CR versus not[2nd/3nd CR and “active disease”]), molecular-cytogenetic risk(intermediate versus poor-risk), response to first chemotherapy( responders versus primary induction failure/PIF), time from diagnosis to transplantation (more or less than 6 months), stem cell source (bone marrow or peripheral blood), donor type (matched related or alternative), severe acute GvHD (grade IIII-IV), chronic GvHD, serological risk CMV status were analyzed as predisposing factors for relapse. Multivariate analysis was performed with the variables identified as relevant at univariate analysis.
Results
Transplantation for AML was done in 1st CR in 53/118 (44%) patients and not in 1st CR in 65/118 (56%) patients. Thirty-nine patients (33%) were PIF and 83/118 (70%) transplants were done within 6 months from diagnosis; 28/118(23%)patients were classified as poor molecular-cytogenetic risk. Twenty-six (18%) suffered GvHD grade III-IV and 32%, 15% and 8% of evaluable patients developed limited, moderate and severe cGvHD. The 2-year relapse incidence was 55%: 36 % for patients in CR1 and 75% for patients not in CR1(p=0.001). At multivariate analysis the disease status (1st CR)(p=0.02 HR 0.73, 95%CI 1.0-2.8) and cGvHD(p=0.001 HR 0.2, 95%CI 0.1-0.4) were the factors associated with a lower relapse incidence. Donor type, molecular-cytogenetic risk, response to first chemotherapy, stem cell source, acute GvHD did not seem to significantly influence relapse.
Conclusion
In our experience allogeneic transplants performed in 1stCR and cGvHD were the main factors influencing the risk of relapse in adult patients with AML. Transplanted patients not in 1st CR and without cGvHD may be a “high relapse risk group” that could benefit from pre-emptive therapy post transplantation also with new drugs.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Relapsed acute myeloid leukemia, Stem cell transplant
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