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Am J Hematol. 2018 Dec 30. doi: 10.1002/ajh.25395. [Epub ahead of print]

Comparative outcomes of myeloablative and reduced-intensity conditioning allogeneic hematopoietic cell transplantation for therapy-related acute myeloid leukemia with prior solid tumor: A report from the acute leukemia working party of the European society for blood and bone marrow transplantation.

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Utah Blood and Marrow Transplantation Program, Huntsman Cancer Institute, Salt Lake City, Utah.
EBMT Paris study office/CEREST-TC, Paris, France.
Department of Haematology, Saint Antoine Hospital, Université Pierre & Marie Curie, INSERM, Paris, France.
Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital of Essen, University of Duisburg-Essen, Germany.
Department of Medicine-Hematology, Oncology, University of Freiburg, Germany.
Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France.
Department of Hematology, Hemostasis, and Oncology, Hannover Medical School, Germany.
Division of Medicine, Department of Hematology and Stem Cell Transplantation Unit, Turku University Hospital, Turku, Finland.
Department D'Hématologie, CHU Nantes, Nantes, France.
Department of Hematology, Centre Hospitalier Lyon Sud, Lyon, France.
Department of Haematology, University Hospital Gasthuisberg, Leuven, Belgium.
CHU de Lille, Université de Lille, Lille, France.
Department of Hematology, Institut Gustave Roussy, Villejuif, France.
Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.


Therapy-related acute myeloid leukemia (t-AML) arises as a late complication following antecedent solid tumors or hematologic diseases and their associated treatments. There are limited data regarding risk factors and outcomes following allogeneic hematopoietic cell transplantation (HCT) for t-AML following a prior solid tumor, and furthermore, the impact of myeloablative (MAC) vs reduced-intensity conditioning (RIC) on survival is unknown. The acute leukemia working party (ALWP) of the European society for blood and bone marrow transplantation (EBMT) performed a large registry study that included 535 patients with t-AML and prior solid tumor who underwent first MAC or RIC allogeneic HCT from 2000-2016. The primary endpoints of the study were OS and LFS. Patients receiving RIC regimens had an increase in relapse incidence (hazard ratio [HR], 1.52; 95% confidence interval [CI] 1.02-2.26; P = 0.04), lower LFS (HR, 1.52; 95% CI 1.12-2.05, P = 0.007), and OS (HR, 1.51; CI 1.09-2.09; P = 0.012). There were no differences in NRM and GRFS. Importantly, LFS and OS were superior in patients receiving ablative regimens due to a decrease in relapse. As NRM continues to decline in the current era, it is conceivable that outcomes of HCT for t-AML with prior solid tumor may be improved by careful patient selection for myeloablative regimens.


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