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Haematologica. 2019 May 2. pii: haematol.2019.216168. doi: 10.3324/haematol.2019.216168. [Epub ahead of print]

Allogeneic stem cell transplantation using HLA-matched donors for acute myeloid leukemia with deletion 5q or monosomy 5: a study from the Acute Leukemia Working Party of the EBMT.

Author information

1
Cliniques Universitaires Saint-Luc; xavier.poire@uclouvain.be.
2
Hôpital Saint Antoine.
3
Hôpital Haut-Leveque.
4
Medizinische Hochschule Hannover.
5
HUCH Comprehensive Cancer Center.
6
Centre Hospitalier Lyon Sud.
7
Departement d'Hematologie et Oncologie pédiatrique.
8
Hôpital Huriez.
9
University Hospital Gasthuisberg.
10
Hospital U. Marqués de Valdecilla.
11
Erasmus MC-Daniel den Hoed Cancer Center.
12
Uniklinik Freiburg.
13
Hospital Clinic.
14
Chaim Sheba Medical Center.

Abstract

Deletion 5q or monosomy 5 (-5/5q-) in acute myeloid leukemia is a common high-risk feature referred to allogeneic stem cell transplantation. However, -5/5q- is frequently associated with other high-risk cytogenetic aberrations such as complex karyotype, monosomal karyotype, monosomy 7 (-7), or 17p abnormalities (abn (17p)), the significance of which is unknown. In order to address this question, we studied adult patients with acute myeloid leukemia harboring -5/5q- having their first allogeneic transplantation between 2000 and 2015. Five hundred and one patients with -5/5q- have been analyzed. Three hundred thirty-eight patients (67%) were in first remission and 142 (28%) had an active disease at time of allogeneic transplantation. The 2-year probabilities of overall survival and leukemia-free survival were 27% and 20%, respectively. The 2-year probability of treatment-related mortality was 20%. We identified 4 different cytogenetic groups according to additional abnormalities with prognostic impact: -5/5q- without complex karyotype, monosomal karyotype or abn(17p), -5/5q- within a complex karyotype, -5/5q- within a monosomal karyotype and the combination of -5/5q- with abn(17p). In multivariate analysis, factors associated with worse overall survival and leukemia-free survival across the 4 groups were active disease, age, monosomal karyotype and abn(17p). The presence of -5/5q- without monosomal karyotype or abn(17p) was associated with a significantly better survival rate while -5/5q- in conjunction with monosomal karyotype or abn(17p) translated into a worse outcome. The patients harboring the combination of -5/5q- with abn(17p) showed very limited benefit from allogeneic transplantation.

KEYWORDS:

Acute Myeloid Leukemia; Cytogenetics and Molecular Genetics; Stem Cell Transplantation; deletion 5q; monosomy 5

PMID:
31048355
DOI:
10.3324/haematol.2019.216168
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