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Leukemia. 2019 May 30. doi: 10.1038/s41375-019-0494-9. [Epub ahead of print]

Prognostic index for patients with relapsed or refractory acute myeloid leukemia who underwent hematopoietic cell transplantation: a KSGCT multicenter analysis.

Author information

1
Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan. tcbn@kcch.jp.
2
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
3
Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
4
Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
5
Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
6
Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.
7
Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
8
Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan.
9
Division of Molecular Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
10
Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
11
Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
12
Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan.
13
Department of Hematology, Chiba University Hospital, Chiba, Japan.
14
Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan.
15
Division of Hematology-Oncology, Japanese Red Cross Society Narita Hospital, Narita, Japan.
16
First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
17
Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
18
Department of Internal Medicine, Chiba Aoba Municipal Hospital, Chiba, Japan.
19
Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan.
20
Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan.

Abstract

A multicenter retrospective study was performed to explore a prognostic scoring index in order to identify a population who are least likely to benefit from allogeneic hematopoietic cell transplantation (HCT) in patients with relapsed or refractory acute myeloid leukemia (AML). The cohort included 519 patients with AML, who received HCT between 2005 and 2015 at a status of relapse or primary induction failure. Multivariate analysis demonstrated five independent predictors for OS, including C-reactive protein ≥ 1 mg/dL, peripheral blood blast fraction ≥ 20%, poor-risk karyotype, performance status ≥ 2, and bone marrow unrelated donor as a stem cell source. A prognostic scoring index was explored based on these predictors, and successfully separated the cohort into four groups. At 2 years, OS was 47%, 24%, 8%, and 0% for Good (Score 0, 1: n = 118), Intermediate-1 (Score 2: n = 75), Intermediate-2 (Score 3: n = 39), and Poor (Score 4: n = 24), respectively (P < 0.001). The predicting value of the index was confirmed in a validation cohort. Although a further validation study is warranted, the scoring index may be useful to predict survival and to identify the population with the lowest survival prior to HCT in patients with relapsed or refractory AML.

PMID:
31147621
DOI:
10.1038/s41375-019-0494-9

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