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Outcome of conditioning intensity in acute myeloid leukemia with monosomal karyotype in patients over 45 year-old: A study from the acute leukemia working party (ALWP) of the European group of blood and marrow transplantation (EBMT).
Am J Hematol. 2015 Aug; 90(8):719-24.AJ

Abstract

Acute myeloid leukemia with monosomal karyotype (MK AML) carries a very poor prognosis, even after allogeneic stem cell transplantation (SCT). However, SCT remains the only curative option in this high-risk population. Because myeloablative conditioning regimen (MAC) is associated with less relapse, we hypothesized that more intensive conditioning regimen might be beneficial for MK AML patients. We reviewed 303 patients over age 45 diagnosed with either de novo or secondary MK AML. One hundred and five patients received a MAC and 198 a reduced-intensity conditioning (RIC). The median age at SCT was 57-year-old, significantly lower in the MAC (53-year-old) than in the RIC group (59-year-old). The median follow-up was 42 months (range, 3 - 156 months). The 3-year overall survival (OS), leukemia-free survival (LFS), and relapse rate (RR) were not significantly different between both groups with overall values of 34%, 29%, and 51%, respectively. On the contrary, the 3-year nonrelapse mortality (NRM) was significantly higher in MAC recipients (28%) compared with RIC patients (16%, P = 0.004). The incidence of Grades II to IV acute graft-versus-host disease (GvHD) was significantly higher after a MAC (30.5%) than after a RIC (19.3%, P = 0.02). That of chronic GvHD was comparable between both groups (35%) and did not impact on LFS. Interestingly, within our MK AML cohort, hypodiploidy was significantly associated with worse outcomes. Due to reduced toxicity and comparable OS, LFS, and RR, RIC appears as a good transplant option in the very high-risk population, including older patients, diagnosed with MK AML.

Authors+Show Affiliations

Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.EBMT Pris Study Office/CEREST-TC, Paris, France.Section of Hematology, Erasmus MC-Daniel Den Hoed Cancer Centre, Rotterdam, The Netherlands.Section of Hematology, Helsinki University Central Hospital, Helsinki, Sweden.Section of Hematology, Hospital U. Marques De Valdecilla, Santander, Spain.Section of Hematology, Leiden University Hospital, Leiden, The Netherlands.Section of Hematology, CHU Bordeaux, Pessac, France.Section of Hematology, Hôpital a Michallon, Grenoble, France.Section of Hematology, Hôpital Huriez, Lille, France.Section of Hematology, University Medical Center Groningen, Groningen, The Netherlands.Section of Hematology, Centre Hospitalier Lyon Sud, Lyon, France.Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.Section of Hematology, Hôpital Saint-Antoine, Paris, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26010466

Citation

Poiré, Xavier, et al. "Outcome of Conditioning Intensity in Acute Myeloid Leukemia With Monosomal Karyotype in Patients Over 45 Year-old: a Study From the Acute Leukemia Working Party (ALWP) of the European Group of Blood and Marrow Transplantation (EBMT)." American Journal of Hematology, vol. 90, no. 8, 2015, pp. 719-24.
Poiré X, Labopin M, Cornelissen JJ, et al. Outcome of conditioning intensity in acute myeloid leukemia with monosomal karyotype in patients over 45 year-old: A study from the acute leukemia working party (ALWP) of the European group of blood and marrow transplantation (EBMT). Am J Hematol. 2015;90(8):719-24.
Poiré, X., Labopin, M., Cornelissen, J. J., Volin, L., Richard Espiga, C., Veelken, J. H., Milpied, N., Cahn, J. Y., Yacoub-Agha, I., van Imhoff, G. W., Michallet, M., Michaux, L., Nagler, A., & Mohty, M. (2015). Outcome of conditioning intensity in acute myeloid leukemia with monosomal karyotype in patients over 45 year-old: A study from the acute leukemia working party (ALWP) of the European group of blood and marrow transplantation (EBMT). American Journal of Hematology, 90(8), 719-24. https://doi.org/10.1002/ajh.24069
Poiré X, et al. Outcome of Conditioning Intensity in Acute Myeloid Leukemia With Monosomal Karyotype in Patients Over 45 Year-old: a Study From the Acute Leukemia Working Party (ALWP) of the European Group of Blood and Marrow Transplantation (EBMT). Am J Hematol. 2015;90(8):719-24. PubMed PMID: 26010466.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome of conditioning intensity in acute myeloid leukemia with monosomal karyotype in patients over 45 year-old: A study from the acute leukemia working party (ALWP) of the European group of blood and marrow transplantation (EBMT). AU - Poiré,Xavier, AU - Labopin,Myriam, AU - Cornelissen,Jan J, AU - Volin,Liisa, AU - Richard Espiga,Carlos, AU - Veelken,J Hendrik, AU - Milpied,Noël, AU - Cahn,Jean-Yves, AU - Yacoub-Agha,Ibrahim, AU - van Imhoff,Gustaaf W, AU - Michallet,Mauricette, AU - Michaux,Lucienne, AU - Nagler,Arnon, AU - Mohty,Mohamad, PY - 2015/01/23/received PY - 2015/05/08/revised PY - 2015/05/15/accepted PY - 2015/5/27/entrez PY - 2015/5/27/pubmed PY - 2015/10/1/medline SP - 719 EP - 24 JF - American journal of hematology JO - Am J Hematol VL - 90 IS - 8 N2 - Acute myeloid leukemia with monosomal karyotype (MK AML) carries a very poor prognosis, even after allogeneic stem cell transplantation (SCT). However, SCT remains the only curative option in this high-risk population. Because myeloablative conditioning regimen (MAC) is associated with less relapse, we hypothesized that more intensive conditioning regimen might be beneficial for MK AML patients. We reviewed 303 patients over age 45 diagnosed with either de novo or secondary MK AML. One hundred and five patients received a MAC and 198 a reduced-intensity conditioning (RIC). The median age at SCT was 57-year-old, significantly lower in the MAC (53-year-old) than in the RIC group (59-year-old). The median follow-up was 42 months (range, 3 - 156 months). The 3-year overall survival (OS), leukemia-free survival (LFS), and relapse rate (RR) were not significantly different between both groups with overall values of 34%, 29%, and 51%, respectively. On the contrary, the 3-year nonrelapse mortality (NRM) was significantly higher in MAC recipients (28%) compared with RIC patients (16%, P = 0.004). The incidence of Grades II to IV acute graft-versus-host disease (GvHD) was significantly higher after a MAC (30.5%) than after a RIC (19.3%, P = 0.02). That of chronic GvHD was comparable between both groups (35%) and did not impact on LFS. Interestingly, within our MK AML cohort, hypodiploidy was significantly associated with worse outcomes. Due to reduced toxicity and comparable OS, LFS, and RR, RIC appears as a good transplant option in the very high-risk population, including older patients, diagnosed with MK AML. SN - 1096-8652 UR - https://www.unboundmedicine.com/medline/citation/26010466/Outcome_of_conditioning_intensity_in_acute_myeloid_leukemia_with_monosomal_karyotype_in_patients_over_45_year_old:_A_study_from_the_acute_leukemia_working_party__ALWP__of_the_European_group_of_blood_and_marrow_transplantation__EBMT__ L2 - https://doi.org/10.1002/ajh.24069 DB - PRIME DP - Unbound Medicine ER -