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Haematologica. 2019 Apr 19. pii: haematol.2018.208678. doi: 10.3324/haematol.2018.208678. [Epub ahead of print]

Allogeneic hematopoietic cell transplantation improves outcome of adults with t(6;9) acute myeloid leukemia - results from an international collaborative study.

Author information

1
Dept of Internal Medicine V University Hospital Heidelberg, Heidelberg, Germany; s.kayser@dkfz-heidelberg.de.
2
Cardiff University School of Medicine, Cardiff, United Kingdom.
3
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
4
Massachusetts General Hospital, Boston, MA, USA.
5
Laboratory of Hematology, André Mignot Hospital, Le Chesnay, France.
6
Dept of Hematology, Oncology, Tumor Immunology, Charite-University Medical Center, Berlin, Germany.
7
Leukemia Service, Dept of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.
8
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
9
University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
10
Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
11
Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
12
Masaryk University and University Hospital Brno, Brno, Czech Republic.
13
Charles University, University Hospital Hradec Kralové, Czech Republic.
14
Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic.
15
Université Paris-Saclay, Gustave Roussy Villejuif, France.
16
Kings College London, Faculty of Life Sciences and Medicine, London, UK.
17
Dept. of Oncology, Hematology and Rheumatology, University Hospital Bonn, Germany.
18
Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
19
Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany.
20
Medical Clinic and Policlinic I, Hematology and Cellular Therapy,University Hospital Leipzig,Germany.
21
Dept. of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany.
22
Dept. of of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany.
23
Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA.
24
Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
25
NCT Trial Center, National Center for Tumor Diseases, Heidelberg, Germany.
26
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA.

Abstract

Acute myeloid leukemia with t(6;9)(p22;q34) is a distinct entity accounting for 1-2% of acute myeloid leukemia cases. A substantial proportion of these patients have a concomitant FLT3-ITD. While outcomes are dismal with intensive chemotherapy, limited evidence suggests allogeneic hematopoietic cell transplantation may improve survival if applied early during first complete remission. We report on a cohort of 178 patients with t(6;9)(p22;q34) within an international, multicenter collaboration. Median age was 46 (range: 16-76) years, acute myeloid leukemia was de novo in 88%, FLT3-ITD was present in 62%, and additional cytogenetic abnormalities in 21%. Complete remission was achieved in 81% (n=144), including 14 patients who received high-dose cytarabine after initial induction failure. With a median follow-up of 5.43 years, estimated overall survival at 5 years was 38% (95%-CI, 31-47%). Allogeneic hematopoietic cell transplantation was performed in 117 (66%) patients, including 89 in first complete remission. Allogeneic hematopoietic cell transplantation in first complete remission was associated with higher 5-year relapse-free and overall survival as compared to consolidation chemotherapy (45% [95%-CI, 35-59%] and 53% [95%-CI, 42-66%], vs. 7% [95%-CI, 3-19%] and 23% [95%-CI, 13-38%]. For patients undergoing allogeneic hematopoietic cell transplantation, overall survival rates at 5 years did not differ whether performed in first (53% [95%-CI, 42-66%]), or second complete remission (58% [95%-CI, 31-100%]; n=10) or with active disease/relapse (54% [95%-CI, 34-84%]; n=18) (P=0.67). Neither FLT3-ITD nor additional chromosomal abnormalities impacted survival. In conclusion, outcomes of t(6;9)(p22;q34) acute myeloid leukemias are poor with chemotherapy, and can be substantially improved with allogeneic hematopoietic cell transplantation.

KEYWORDS:

Acute Myeloid Leukemia; Cytogenetics and Molecular Genetics; Hematopoietic Stem Cell; Outcome; t(6;9)(p22;q34)/DEK-NUP214

PMID:
31004014
DOI:
10.3324/haematol.2018.208678
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