High probability of long-term survival in 2-year survivors of autologous hematopoietic cell transplantation for AML in first or second CR

• Published in: Bone marrow transplantation (Basingstoke) Vol. 46; no. 3; pp. 385 - 392
• Main Authors: MAJHAIL, N. S, BAJORUNAITE, R, LAZARUS, H. M, WANG, Z, KLEIN, J. P, ZHANG, M. J, RIZZO, J. D
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.03.2011
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Autografts; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Cancer survivors; Care and treatment; Child; Cohort Studies; Confidence intervals; Cytogenetics; Disease-Free Survival; Female; Growth factors; Health risks; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Leukemia, Myeloid, Acute - surgery; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Mortality; Multivariate analysis; Prognosis; Remission; Remission (Medicine); Remission Induction - methods; Risk analysis; Risk factors; Statistical analysis; Stem cell transplantation; Survival; Survival Analysis; Survivors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning; Transplantation, Autologous; Treatment Outcome; Young Adult; United States; AML; Acute myelogenous leukemia; Relapse; autologous HCT; Hematology; Survivor; Stem cell; Mortality; Hematopoietic cell; Malignant hemopathy; First complete remission; Long term; Survival; Autologous hematopoietic stem cell transplantation; overall survival; Graft; Survival probability; relative mortality; Cancer
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2010.115

We describe the long-term outcomes of autologous hematopoietic cell transplantation (HCT) for 315 AML patients in first or second complete remission (CR). All patients were in continuous CR for ≥2 years after HCT. Patients were predominantly transplanted in CR1 (78%) and had good or intermediate cytogenetic risk disease (74%). Median follow-up of survivors was 106 (range, 24-192) months. Overall survival at 10 years after HCT was 94% (95% confidence intervals, 89-97%) and 80% (67-91%) for patients receiving HCT in CR1 and CR2, respectively. The cumulative incidence of relapse at 10 years after HCT was 6% (3-10%) and 10% (3-20%) and that of nonrelapse mortality was 5% (2-9%) and 11% (4-21%), respectively. On multivariate analysis, HCT in CR2 (vs CR1), older age at transplantation and poor cytogenetic risk disease were independent predictors of late mortality and adverse disease-free survival. The use of growth factors to promote engraftment after HCT was the only risk factor for relapse. Relative mortality of these 2-year survivors was comparable to that of age-, race- and gender-matched normal population. Patients who receive autologous HCT for AML in CR1 or CR2 and remain in remission for ≥2 years have very favorable long-term survival. Their mortality rates are similar to that of the general population.