Relapse and survival after transplantation for complex karyotype acute myeloid leukemia: A report from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation and the University of Texas MD Anderson Cancer Center

• Published in: Cancer Vol. 124; no. 10; pp. 2134 - 2141
• Main Authors: Ciurea, Stefan O., Labopin, Myriam, Socie, Gerard, Volin, Liisa, Passweg, Jakob, Chevallier, Patrice, Beelen, Dietrich, Milpied, Noel, Blaise, Didier, Cornelissen, Jan J., Fegueux, Nathalie, Polge, Emmanuelle, Kongtim, Piyanuch, Rondon, Gabriela, Esteve, Jordi, Mohty, Mohamad, Savani, Bipin N., Champlin, Richard E., Nagler, Arnon
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15.05.2018
• Subjects: Abnormalities; Acute myeloid leukemia; Adult; Age; Aged; allogeneic stem cell transplantation; Blood; Cancer; Chromosome Aberrations; Clonal deletion; complex karyotype; Databases, Factual - statistics & numerical data; Disease-Free Survival; Donors; Female; Graft vs Host Disease - prevention & control; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic Stem Cell Transplantation - statistics & numerical data; Hematopoietic stem cells; Histocompatibility antigen HLA; Histocompatibility Testing; HLA Antigens - immunology; Humans; Karyotype; Karyotyping; Leukemia; Leukemia, Myeloid, Acute - genetics; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - therapy; Leukocytes; Male; Medical prognosis; Middle Aged; Monosomy; Multivariate analysis; myeloablative conditioning; Myeloid leukemia; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - prevention & control; Neoplasms, Second Primary - genetics; Neoplasms, Second Primary - mortality; Neoplasms, Second Primary - therapy; Oncology; Patients; reduced‐intensity conditioning; Retrospective Studies; Stem cell transplantation; Stem cells; Survival; Texas - epidemiology; Tissue Donors - statistics & numerical data; Transplantation; Transplantation Conditioning - methods; Transplantation Conditioning - statistics & numerical data; Transplantation, Homologous - adverse effects; Transplantation, Homologous - methods; Transplantation, Homologous - statistics & numerical data; Young Adult; Texas; United States > US; allogeneic stem cell transplantation; acute myeloid leukemia; myeloablative conditioning; reduced-intensity conditioning; complex karyotype
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.31311

BACKGROUND Despite recent advances in allogeneic hematopoietic stem cell transplantation (AHSCT), the outcome of patients who have acute myeloid leukemia (AML) with a complex karyotype (CK) remains poor. The objective of this study was to identify prognostic factors associated with post‐transplantation survival in a large cohort of patients with CK AML. METHODS In total, data on 1342 consecutively patients who underwent transplantation for CK (≥3 chromosomal abnormalities) AML were provided by the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation and from the University of Texas MD Anderson Cancer Center database were included in the analysis. The median patient age was 52 years. The donors were human leukocyte antigen‐matched related donors (N = 749), matched unrelated donors (N = 513), and mismatched unrelated donors (N = 80). RESULTS Relapse was the main cause of treatment failure. Overall, 51% of patients relapsed, 17.6% died of treatment‐related mortality, and 31.3% survived leukemia‐free. In multivariate analysis, the factors associated with an increased risk of relapse were age (>40 years; hazard ratio [HR], 1.1 per 10 years; P = .02), secondary AML (HR, 1.35; P = .01), active disease at transplantation (HR, 1.98; P < .001), and deletion/monosomy 5 (HR, 1.5; P < .001); whereas age (HR, 1.15 per 10 years; P < .001), secondary AML (HR, 1.36; P = .001), active disease at transplantation (HR, 1.99; P < .001), deletion/monosomy 5 (HR, 1.24; P = .008), and deletion/monosomy 7 (HR, 1.44; P < .001) predicted for leukemia‐free survival. CONCLUSIONS Disease relapse remains the most common cause of treatment failure for patients with CK AML after transplantation. Novel approaches to decrease the relapse rate and improve survival are needed in these patients. Cancer 2018;124:2134‐41. © 2018 American Cancer Society. Disease relapse remains the most common cause of treatment failure for patients with complex karyotype acute myeloid leukemia after transplantation. Age, secondary acute myeloid leukemia, transplantation in active disease, and deletion/monosomy5 were associated with an increased risk of post‐transplantation relapse in patients with complex karyotype acute myeloid leukemia.