Brissot, Eolia and Labopin, Myriam and Stelljes, Matthias and Ehninger, Gerhard and Schwerdtfeger, Rainer and Finke, Juergen and Kolb, Hans-Jochem and Ganser, Arnold and Schaefer-Eckart, Kerstin and Zander, Axel R. and Bunjes, Donald and Mielke, Stephan and Bethge, Wolfgang A. and Milpied, Noel and Kalhs, Peter and Blau, Igor-Woflgang and Kroeger, Nicolaus and Vitek, Antonin and Gramatzki, Martin and Holler, Ernst and Schmid, Christoph and Esteve, Jordi and Mohty, Mohamad and Nagler, Arnon (2017) Comparison of matched sibling donors versus unrelated donors in allogeneic stem cell transplantation for primary refractory acute myeloid leukemia: a study on behalf of the Acute Leukemia Working Party of the EBMT. JOURNAL OF HEMATOLOGY & ONCOLOGY, 10: 130. ISSN 1756-8722,
Full text not available from this repository. (Request a copy)Abstract
Background: Primary refractory acute myeloid leukemia (PRF-AML) is associated with a dismal prognosis. Allogeneic stem cell transplantation (HSCT) in active disease is an alternative therapeutic strategy. The increased availability of unrelated donors together with the significant reduction in transplant-related mortality in recent years have opened the possibility for transplantation to a larger number of patients with PRF-AML. Moreover, transplant from unrelated donors may be associated with stronger graft-mediated anti-leukemic effect in comparison to transplantations from HLA-matched sibling donor, which may be of importance in the setting of PRF-AML. Methods: The current study aimed to address the issue of HSCT for PRF-AML and to compare the outcomes of HSCT from matched sibling donors (n = 660) versus unrelated donors (n = 381), for patients with PRF-AML between 2000 and 2013. The Kaplan-Meier estimator, the cumulative incidence function, and Cox proportional hazards regression models were used where appropriate. Results: HSCT provide patients with PRF-AML a 2-year leukemia-free survival and overall survival of about 25 and 30%, respectively. In multivariate analysis, two predictive factors, cytogenetics and time from diagnosis to transplant, were associated with lower leukemia-free survival, whereas Karnofsky performance status at transplant >= 90% was associated with better leukemia-free survival (LFS). Concerning relapse incidence, cytogenetics and time from diagnosis to transplant were associated with increased relapse. Reduced intensity conditioning regimen was the only factor associated with lower non-relapse mortality. Conclusions: HSCT was able to rescue about one quarter of the patients with PRF-AML. The donor type did not have any impact on PRF patients' outcomes. In contrast, time to transplant was a major prognostic factor for LFS. For patients with PRF-AML who do not have a matched sibling donor, HSCT from an unrelated donor is a suitable option, and therefore, initiation of an early search for allocating a suitable donor is indicated.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ACUTE MYELOGENOUS LEUKEMIA; HLA-IDENTICAL SIBLINGS; VERSUS-HOST-DISEASE; MYELODYSPLASTIC SYNDROME; MAINTENANCE THERAPY; REDUCED-INTENSITY; MARROW-TRANSPLANTATION; GEMTUZUMAB OZOGAMICIN; PERFORMANCE STATUS; COMORBIDITY INDEX; Acute myeloid leukemia; Refractory; Allogeneic stem cell transplantation; HLA-matched related donor; Unrelated donor; Graft-versus-host disease |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin III (Hämatologie und Internistische Onkologie) |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 14 Dec 2018 13:10 |
| Last Modified: | 20 Feb 2019 14:17 |
| URI: | https://pred.uni-regensburg.de/id/eprint/676 |
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