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Leukemia. 2019 Jul 30. doi: 10.1038/s41375-019-0527-4. [Epub ahead of print]

Allogeneic haemopoietic transplantation for acute myeloid leukaemia in second complete remission: a registry report by the Acute Leukaemia Working Party of the EBMT.

Author information

1
Department of Haematology, Leeds Teaching Hospitals Trust, Leeds, UK. mgilleece@nhs.net.
2
EBMT Paris study office/CEREST-TC, Paris, France.
3
Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
4
CHU de Lille, LIRIC, INSER U995, Université de Lille, Lille, France.
5
Hematologie / Transplantation, Hôpital St Louis, Paris, CEDEX 10, France.
6
Section for Hematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
7
Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France.
8
Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
9
Queen Elizabeth Medical Centre, University Hospital Birmingham NHS Trust, Department of Haematology, Birmingham, UK.
10
Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Haematology, Rotterdam, Netherlands.
11
Tor Vergata University of Rome, Policlinico Universitario Tor Vergata, Stem Cell Transplant Unit, Rome, Italy.
12
Service Hématologie Clinique et Thérapie Cellulaire, Hôpital Haut-Lévêque - CHU, Bordeaux, France.
13
Addenbrookes Hospital, Department of Haematology, Cambridge, UK.
14
Acute Leukemia Working Party, European Society for Blood and Marrow Transplantation Paris Study Office/European Center for Biostatistical and Epidemiological Evaluation in Hematopoietic Cell Therapy (CEREST-TC), Paris, France.
15
Hôpital Saint Antoine, INSERM UMR 938, Paris, France.
16
Université Pierre et Marie Curie, Paris, France.
17
Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.

Abstract

Allogeneic haemopoietic cell transplant (allo-HCT) may be curative in acute myeloid leukaemia (AML) in second complete remission (CR2) but the impact of reduced intensity (RIC) versus myeloablative conditioning (MAC) is uncertain. The Acute Leukaemia Working Party of the European Society for Blood and Bone Marrow Transplantation Registry studied an AML CR2 cohort characterised by age ≥ 18 years, first allo-HCT 2007-2016, available cytogenetic profile at diagnosis, donors who were matched family, volunteer unrelated with HLA antigen match 10/10 or 9/10 or haplo-identical. The 1879 eligible patients included 1010 (54%) MAC allo-HCT recipients. In patients <50 years (y), two year outcomes for MAC vs RIC allo-HCT were equivalent with leukaemia-free survival (LFS) 54% for each, overall survival (OS), 61% vs 62%, non-relapse mortality (NRM) 18% vs 15% and graft versus host disease relapse-free survival (GRFS) 38% vs 42%. In patients ≥50 y, 2 y outcomes for MAC vs RIC allo-HCT were equivalent for LFS 52% vs 49%, OS 58% vs 55% and GRFS 42.4% vs 36%. However, NRM was significantly inferior after MAC allo-HCT, 27% vs 19% (P = 0.01) despite worse cGVHD after RIC-allo (32% vs 39%). These data support the need for ongoing prospective study of conditioning intensity and GVHD mitigation in AML.

PMID:
31363160
DOI:
10.1038/s41375-019-0527-4

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