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Long-term survival and late events after allogeneic stem cell transplantation from HLA-matched siblings for acute myeloid leukemia with myeloablative compared to reduced-intensity conditioning: a report on behalf of the acute leukemia working party of European group for blood and marrow transplantation.
J Hematol Oncol. 2016 11 08; 9(1):118.JH

Abstract

BACKGROUND

Myeloablative (MAC) and reduced-intensity conditioning (RIC) are established approaches for allogeneic stem cell transplantation (SCT) in acute myeloid leukemia (AML). Most deaths after MAC occur within the first 2 years after SCT, while patients surviving leukemia-free for 2 years can expect a favorable long-term outcome. However, there is paucity of data on the long-term outcome (beyond 10 years) and the pattern of late events following RIC due to the relative recent introduction of this approach.

METHODS

We analyzed long-term outcomes in a cohort of 1423 AML patients, age ≥50 years, after SCT from HLA-matched siblings, during the years 1997-2005, median follow-up 8.3 years (0.1-17).

RESULTS

The 10-year leukemia-free survival (LFS) was 31 % (95CI, 27-35) and 32 % (28-35) after MAC and RIC, respectively (P = 0.57). The 10-year GVHD/ relapse-free survival (GRFS), a surrogate for quality of life was 22 % (18-25) and 21 % (18-24), respectively (P = 0.79). The 10-year non-relapse mortality (NRM) was higher and relapse rate was lower after MAC, throughout the early and late post-transplant course. The 10-year LFS among 584 patients surviving leukemia-free 2 years after SCT was 71 % (65-76) and 73 % (67-78) after MAC and RIC, respectively (P = 0.76). Advanced leukemia at SCT was the major predictor of LFS subsequent to the 2-year landmark. Relapse was the major cause of late death after both regimens; however, NRM and in particular chronic graft-versus-host disease and second cancers were more common causes of late death after MAC.

CONCLUSIONS

Long-term LFS and GRFS are similar after RIC and MAC. Most events after RIC or MAC occur within the first 2 years after SCT. Patients who are leukemia-free 2 years after SCT can expect similar good subsequent outcome after both approaches.

Authors+Show Affiliations

Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel HaShomer and Tel-Aviv University, Tel Aviv, Israel. ashimoni@sheba.health.gov.il.Hôpital Saint Antoine, ALWP office, Service d'Hématologie et de Thérapie cellulaire, Paris, France.Vanderbilt University Hematology and Transplantation, Nashville, USA.Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center, Helsinki, Finland.Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany.Department of Haematology, University Medical Centre, Utrecht, The Netherlands.Klinik fuer Innere Medzin III, Universitätsklinikum Ulm, Ulm, Germany.Department of Hematology, Nijmegen Medical Centre, Nijmegen, The Netherlands.CHU Bordeaux, Hôpital Haut-leveque, Pessac, France.Department of Haematology II, Ospedale San Martino, Genoa, Italy.Leiden University Hospital, BMT Centre Leiden, Leiden, The Netherlands.Hematology Department, IIB Sant Pau and Josep Carreras Leukemia Research Institutes, Hospital Santa Creu i Sant Pau, Barcelona, Spain.Department of Haematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.University Hospital Leipzig, Division of Haematology and Oncology, Leipzig, Germany.Hôpital Saint Antoine, ALWP office, Service d'Hématologie et de Thérapie cellulaire, Paris, France.Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel HaShomer and Tel-Aviv University, Tel Aviv, Israel. Hôpital Saint Antoine, ALWP office, Service d'Hématologie et de Thérapie cellulaire, Paris, France.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

27821187

Citation

Shimoni, Avichai, et al. "Long-term Survival and Late Events After Allogeneic Stem Cell Transplantation From HLA-matched Siblings for Acute Myeloid Leukemia With Myeloablative Compared to Reduced-intensity Conditioning: a Report On Behalf of the Acute Leukemia Working Party of European Group for Blood and Marrow Transplantation." Journal of Hematology & Oncology, vol. 9, no. 1, 2016, p. 118.
Shimoni A, Labopin M, Savani B, et al. Long-term survival and late events after allogeneic stem cell transplantation from HLA-matched siblings for acute myeloid leukemia with myeloablative compared to reduced-intensity conditioning: a report on behalf of the acute leukemia working party of European group for blood and marrow transplantation. J Hematol Oncol. 2016;9(1):118.
Shimoni, A., Labopin, M., Savani, B., Volin, L., Ehninger, G., Kuball, J., Bunjes, D., Schaap, N., Vigouroux, S., Bacigalupo, A., Veelken, H., Sierra, J., Eder, M., Niederwieser, D., Mohty, M., & Nagler, A. (2016). Long-term survival and late events after allogeneic stem cell transplantation from HLA-matched siblings for acute myeloid leukemia with myeloablative compared to reduced-intensity conditioning: a report on behalf of the acute leukemia working party of European group for blood and marrow transplantation. Journal of Hematology & Oncology, 9(1), 118.
Shimoni A, et al. Long-term Survival and Late Events After Allogeneic Stem Cell Transplantation From HLA-matched Siblings for Acute Myeloid Leukemia With Myeloablative Compared to Reduced-intensity Conditioning: a Report On Behalf of the Acute Leukemia Working Party of European Group for Blood and Marrow Transplantation. J Hematol Oncol. 2016 11 8;9(1):118. PubMed PMID: 27821187.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term survival and late events after allogeneic stem cell transplantation from HLA-matched siblings for acute myeloid leukemia with myeloablative compared to reduced-intensity conditioning: a report on behalf of the acute leukemia working party of European group for blood and marrow transplantation. AU - Shimoni,Avichai, AU - Labopin,Myriam, AU - Savani,Bipin, AU - Volin,Liisa, AU - Ehninger,Gerhard, AU - Kuball,Jurgen, AU - Bunjes,Donald, AU - Schaap,Nicolaas, AU - Vigouroux,Stephane, AU - Bacigalupo,Andrea, AU - Veelken,Hendrik, AU - Sierra,Jorge, AU - Eder,Matthias, AU - Niederwieser,Dietger, AU - Mohty,Mohamad, AU - Nagler,Arnon, Y1 - 2016/11/08/ PY - 2016/09/05/received PY - 2016/10/18/accepted PY - 2016/11/9/entrez PY - 2016/11/9/pubmed PY - 2017/12/2/medline KW - Acute myeloid leukemia KW - Allogeneic stem cell transplantation KW - Long-term outcome KW - Myeloablative conditioning KW - Reduced-intensity conditioning SP - 118 EP - 118 JF - Journal of hematology & oncology JO - J Hematol Oncol VL - 9 IS - 1 N2 - BACKGROUND: Myeloablative (MAC) and reduced-intensity conditioning (RIC) are established approaches for allogeneic stem cell transplantation (SCT) in acute myeloid leukemia (AML). Most deaths after MAC occur within the first 2 years after SCT, while patients surviving leukemia-free for 2 years can expect a favorable long-term outcome. However, there is paucity of data on the long-term outcome (beyond 10 years) and the pattern of late events following RIC due to the relative recent introduction of this approach. METHODS: We analyzed long-term outcomes in a cohort of 1423 AML patients, age ≥50 years, after SCT from HLA-matched siblings, during the years 1997-2005, median follow-up 8.3 years (0.1-17). RESULTS: The 10-year leukemia-free survival (LFS) was 31 % (95CI, 27-35) and 32 % (28-35) after MAC and RIC, respectively (P = 0.57). The 10-year GVHD/ relapse-free survival (GRFS), a surrogate for quality of life was 22 % (18-25) and 21 % (18-24), respectively (P = 0.79). The 10-year non-relapse mortality (NRM) was higher and relapse rate was lower after MAC, throughout the early and late post-transplant course. The 10-year LFS among 584 patients surviving leukemia-free 2 years after SCT was 71 % (65-76) and 73 % (67-78) after MAC and RIC, respectively (P = 0.76). Advanced leukemia at SCT was the major predictor of LFS subsequent to the 2-year landmark. Relapse was the major cause of late death after both regimens; however, NRM and in particular chronic graft-versus-host disease and second cancers were more common causes of late death after MAC. CONCLUSIONS: Long-term LFS and GRFS are similar after RIC and MAC. Most events after RIC or MAC occur within the first 2 years after SCT. Patients who are leukemia-free 2 years after SCT can expect similar good subsequent outcome after both approaches. SN - 1756-8722 UR - https://www.unboundmedicine.com/medline/citation/27821187/Long_term_survival_and_late_events_after_allogeneic_stem_cell_transplantation_from_HLA_matched_siblings_for_acute_myeloid_leukemia_with_myeloablative_compared_to_reduced_intensity_conditioning:_a_report_on_behalf_of_the_acute_leukemia_working_party_of_European_group_for_blood_and_marrow_transplantation_ L2 - https://jhoonline.biomedcentral.com/articles/10.1186/s13045-016-0347-1 DB - PRIME DP - Unbound Medicine ER -