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Br J Haematol. 2015 Oct;171(2):239-246. doi: 10.1111/bjh.13576. Epub 2015 Jul 26.

Achievement of complete remission predicts outcome of allogeneic haematopoietic stem cell transplantation in patients with chronic myelomonocytic leukaemia. A study of the Chronic Malignancies Working Party of the European Group for Blood and Marrow Transplantation.

Author information

1
Haematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece.
2
Department of Medical Statistics & Bioinformatics, Leiden University Medical Centre, Leiden, the Netherlands.
3
GIMEMA Data Centre, Rome, Italy.
4
Department of Medicine, Haematology, Oncology, University of Freiburg, Freiburg, Germany.
5
Department of Bone Marrow Transplantation, University Hospital, Essen, Germany.
6
Medizinische Klinik und Poliklinik I, Universitätsklinikum Technische Universität Dresden, Dresden, Germany.
7
Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, the Netherlands.
8
Stem Cell Transplantation Unit, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland.
9
Department of Haematological Medicine, GKT School of Medicine, London, UK.
10
Département des Spécialités de Médecine Service d'Hématologie, Hôpitaux Universitaires de Genève, and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
11
Department of Haematology, Haemostasis and Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
12
Division of Haematology, Città della Salute e della Scienza di Torino, Torino, Italy.
13
Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.
14
Division of Haematology, Oncology and Haemostasiology, University of Leipzig, Leipzig, Germany.
15
Department for Haematology, Oncology and Clinical Immunology, University Hospital Dusseldorf, Heinrich Heine University, Dusseldorf, Germany.
16
Deutsche Klinik fur Diagnostik, KMT Zentrum, Wiesbaden, Germany.
17
Department of Tumourimmunology, Radboud University Medical Centre, Nijmegen, the Netherlands.
18
Department of Haematology and BMT, Hopital Saint Louis, Paris, France.
19
Department of Stem Cell Transplantation, University Medical Centre Hamburg, Hamburg, Germany.

Abstract

The results of allogeneic stem cell transplantation (allo-SCT) in chronic myelomonocytic leukaemia (CMML) are usually reported together with other categories of myelodysplastic syndrome. We analysed transplantation outcome in 513 patients with CMML, with a median age of 53 years reported to the European Group for Blood and Marrow Transplantation. Conditioning was standard (n = 249) or reduced-intensity (n = 226). Donors were human leucocyte antigen-related (n = 285) or unrelated (n = 228). Disease status at transplantation was complete remission (CR) in 122 patients, no CR in 344, and unknown in 47. Engraftment was successful in 95%. Grades 2-4 acute graft-versus-host disease (GvHD) occurred in 33% of the patients and chronic GvHD was reported in 24%. The 4-year cumulative incidence of non-relapse mortality was 41% and 32% for relapse, resulting in a 4-year estimated relapse-free and overall survival (OS) of 27% and 33%, respectively. Patients transplanted in CR had lower probability for non-relapse death (P = 0·002) and longer relapse-free and OS (P = 0·001 and P = 0·005, respectively). In multivariate analysis the only significant prognostic factor for survival was the presence of CR at transplantation (P = 0·005). Allo-SCT remains a curative treatment option for patients with CMML and should preferably be performed early after diagnosis or after establishing the best possible remission status.

KEYWORDS:

WHO classification; allogeneic stem cell transplantation; chronic myelomonocytic leukaemia; prognosis; survival

PMID:
26212516
DOI:
10.1111/bjh.13576
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