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Unrelated donor allogeneic transplantation after failure of autologous transplantation for acute myelogenous leukemia: a study from the center for international blood and marrow transplantation research.
- Source :
-
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2013 Jul; Vol. 19 (7), pp. 1102-8. Date of Electronic Publication: 2013 Apr 28. - Publication Year :
- 2013
-
Abstract
- The survival of patients with relapsed acute myelogenous leukemia (AML) after autologous hematopoietic stem cell transplantation (auto-HCT) is very poor. We studied the outcomes of 302 patients who underwent secondary allogeneic hematopoietic cell transplantation (allo-HCT) from an unrelated donor (URD) using either myeloablative (n = 242) or reduced-intensity conditioning (RIC; n = 60) regimens reported to the Center for International Blood and Marrow Transplantation Research. After a median follow-up of 58 months (range, 2 to 160 months), the probability of treatment-related mortality was 44% (95% confidence interval [CI], 38%-50%) at 1-year. The 5-year incidence of relapse was 32% (95% CI, 27%-38%), and that of overall survival was 22% (95% CI, 18%-27%). Multivariate analysis revealed a significantly better overal survival with RIC regimens (hazard ratio [HR], 0.51; 95% CI, 0.35-0.75; P <.001), with Karnofsky Performance Status score ≥90% (HR, 0.62; 95% CI, 0.47-0.82: P = .001) and in cytomegalovirus-negative recipients (HR, 0.64; 95% CI, 0.44-0.94; P = .022). A longer interval (>18 months) from auto-HCT to URD allo-HCT was associated with significantly lower riak of relapse (HR, 0.19; 95% CI, 0.09-0.38; P <.001) and improved leukemia-free survival (HR, 0.53; 95% CI, 0.34-0.84; P = .006). URD allo-HCT after auto-HCT relapse resulted in 20% long-term leukemia-free survival, with the best results seen in patients with a longer interval to secondary URD transplantation, with a Karnofsky Performance Status score ≥90%, in complete remission, and using an RIC regimen. Further efforts to reduce treatment-related mortaility and relapse are still needed.<br /> (Copyright © 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Aged
Child
Child, Preschool
Female
Follow-Up Studies
Graft vs Host Disease immunology
Graft vs Host Disease mortality
Graft vs Host Disease pathology
Humans
Infant
International Cooperation
Leukemia, Myeloid, Acute immunology
Leukemia, Myeloid, Acute mortality
Leukemia, Myeloid, Acute pathology
Male
Middle Aged
Recurrence
Survival Analysis
Transplantation, Autologous
Transplantation, Homologous
Unrelated Donors
Antineoplastic Agents therapeutic use
Graft vs Host Disease prevention & control
Hematopoietic Stem Cell Transplantation methods
Leukemia, Myeloid, Acute therapy
Transplantation Conditioning
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6536
- Volume :
- 19
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 23632091
- Full Text :
- https://doi.org/10.1016/j.bbmt.2013.04.022