-
Armand Keating,
Gisela Tunes da Silva, Waleska S Perez,
Vikas Gupta,
Corey S Cutler,
Karen K Ballen,
Mitchell S Cairo,
Bruce M Camitta,
Richard E Champlin,
James L Gajewski,
Hillard M Lazarus,
Michael Lill,
David I Marks,
Chadi Nabhan,
Gary J Schiller,
Gerard Socie,
Jeffrey Szer,
Martin S Tallman,
Daniel J Weisdorf
[show abstract]
[hide abstract]
ABSTRACT: Background. Optimum post-remission treatment for acute myeloid leukemia in first complete remission remains uncertain. Previous comparisons of autologous versus allogeneic hematopoietic cell transplantation noted higher relapse, but lower treatment-related mortality though using bone marrow grafts with treatment-related mortality of 12-20%. Design and Methods. Recognizing lower treatment-related mortality using autologous peripheral blood grafts, in an analysis of registry data from the Center for International Blood and Transplant Research, we compared treatment related mortality, relapse, leukemia-free survival, and overall survival for acute myeloid leukemia in first complete remission (median ages 36-44, range 19-60) receiving myeloablative HLA-matched sibling donor (bone marrow, n=475 or peripheral blood, n=428) versus autologous peripheral blood (n=230). Results. Five year cumulative incidence of treatment-related mortality was 19 (95% confidence interval,16-23)%, 20(17-24)% and 8(5-12)% and relapse 20(17-24)% 26(21-30)% and 45(38-52)% for allogeneic bone marrow, allogeneic peripheral blood and autologous peripheral blood, respectively. At 5 years, leukemia-free survival and overall survival were similar: allogeneic bone marrow 61(56-65)% and 64(59-68)%; allogeneic peripheral blood 54(49-59)% and 59(54-64)%; autologous peripheral blood 47(40-54)% and 54(47-60)%; p=0.13 and 0.19, respectively. In multivariate analysis treatment-related mortality was lower after autologous peripheral blood versus allogeneic bone marrow / peripheral blood [relative risk 0.37(0.20-0.69); p=0.001], but treatment failure (death or relapse) after autologous peripheral blood was significantly more likely [relative risk 1.32(1.06-1.64); p=0.011]. Five year overall survival, however was similar in patients who received an autologous peripheral blood (n=230) [relative risk 1.23(0.98-1.55) p=0.071] or allogeneic bone marrow / peripheral blood (n=903). Conclusions. In the absence of a HLA-matched sibling donor, autologous peripheral blood may provide acceptable alternative post-remission therapy for acute myeloid leukemia first complete remission.
Haematologica 09/2012; · 6.42 Impact Factor
-
Philippe Armand,
Haesook T Kim,
Mei-Jie Zhang, Waleska S Perez,
Paola S Dal Cin,
Thomas R Klumpp,
Edmund K Waller,
Mark R Litzow,
Jane L Liesveld,
Hillard M Lazarus, [......],
Donald W Bunjes,
Effie W Petersdorf,
Steven M Devine,
Richard T Maziarz,
Martin Bornhauser,
Victor A Lewis,
David I Marks,
Christopher N Bredeson,
Robert J Soiffer,
Daniel J Weisdorf
[show abstract]
[hide abstract]
ABSTRACT: Cytogenetics play a major role in determining the prognosis of patients with acute myelogenous leukemia (AML). However, existing cytogenetics classifications were developed in chemotherapy-treated patients and might not be optimal for patients undergoing allogeneic hematopoietic cell transplantation (HCT). We studied 821 adult patients reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) who underwent HCT for AML in first or second complete remission between 1999 and 2004. We compared the ability of the 6 existing classifications to stratify patients by overall survival. We then defined a new scheme specifically applicable to patients undergoing HCT using this patient cohort. Under this scheme, inv(16) is favorable, a complex karyotype (4 or more abnormalities) is adverse, and all other classified abnormalities are intermediate in predicting survival after HCT (5-year overall survival, 64%, 18%, and 50%, respectively; P = .0001). This scheme stratifies patients into 3 groups with similar nonrelapse mortality, but significantly different incidences of relapse, overall and leukemia-free survival. It applies to patients regardless of disease status (first or second complete remission), donor type (matched related or unrelated), or conditioning intensity (myeloablative or reduced intensity). This transplantation-specific classification could be adopted for prognostication purposes and to stratify patients with AML and karyotypic abnormalities entering HCT clinical trials.
Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 07/2011; 18(2):280-8. · 3.15 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The addition of antithymocyte globulin (ATG) to a regimen of high-dose cyclophosphamide has been advocated to enhance engraftment after allogeneic bone marrow transplantation (BMT) for severe aplastic anemia (SAA). In a prospective clinical trial, 134 patients were randomly assigned to receive cyclophosphamide alone or in combination with ATG. All patients received T-cell-replete bone marrow from an HLA-matched sibling. With a median follow-up of 6 years, the 5-year probabilities of survival were 74% for the cyclophosphamide alone group and 80% for the cyclophosphamide plus ATG group (P = .44). Graft failure and graft-versus-host disease (GVHD) rates were similar in both groups. With the survival rates achieved, this study is not adequately powered to detect significant differences between the 2 treatment groups. In conclusion, the results of allogeneic BMT for SAA have improved over time related to advances in supportive care. The addition of ATG to the preparative regimen did not significantly improve the outcome.
Blood 06/2007; 109(10):4582-5. · 9.90 Impact Factor
