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Biol Blood Marrow Transplant. 2019 Nov 20. pii: S1083-8791(19)30788-8. doi: 10.1016/j.bbmt.2019.11.021. [Epub ahead of print]

Post remission consolidation by autologous HCT for AML in CR1, negative implications for subsequent allogeneic HCT in CR2. A Study by the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT).

Author information

1
University Hospital - Hematology, Basel, Switzerland. Electronic address: jakob.passweg@usb.ch.
2
Department of Hematology and Cell Therapy, Institut National de la Santé et de la Recherche Médicale (INSERM) UMRs 938, Hopital Saint Antoine Assistance Publique-Hopitaux de Paris, Paris Sorbonne University, Paris, France.
3
University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
4
Erasmus MC Cancer Institute University Medical Center Rotterdam Department of Hematology Rotterdam Netherlands.
5
Department of Medical Oncology; University Hospital, Bern, Switzerland.
6
Hopital St. Louis Dept.of Hematology - BMT Paris France.
7
Nottingham University Haematology Nottingham City Hospital Nottingham UK.
8
CHU de Lille, LIRIC, INSERM U995, université de Lille, 59000 Lille, France.
9
Programme de Transplantation&Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille Institut Paoli Calmettes Marseille, France.
10
Oslo University Hospital, Rikshospitalet, Hematology Dept and Institute for Clinical Medicine, University of Oslo, Norway.
11
Centre Hospitalier Lyon Sud Hospices Civils de Lyon Lyon, France.
12
Centre for Clinical Haematology Queen Elizabeth Hospital Birmingham UK.
13
CHU Bordeaux - Hôpital Haut-Leveque, Pessac, France.
14
Hôpital Henri Mondor Wervice d` Hematologie Creteil France.
15
Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT); EBMT Paris Office.
16
Romagna Transplant Network- Ravenna, Italy.
17
Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Ramat Gan, Israel.

Abstract

After autologous hematopoetic cell transplantation, (HCT in 1st complete remission (CR1), patients with acute myeloid leukemia (AML) may relapse and undergo allogeneic HCT in CR2. The aim of this study was to analyze outcome of allogeneic HCT performed in CR2 comparing patients with prior consolidation by autologous HCT vs. patients with chemotherapy consolidation. Included were 2619 adults, with allogeneic HCT in CR2, in 2000-2017 with (n=417) or without (n=2202) prior autologous HCT. Patient groups were not entirely comparable; patients with prior autologous HCT were younger, had less often a favorable cytogenetic profile, had more commonly donors other than matched siblings and more often received reduced intensity conditioning (RIC) conditioning. In multivariate analysis non relapse mortality (NRM) risks in patients with prior autologous HCT were 1.34 (1.07-1.67), p=0.01 after adjustment for age, cytogenetic risk, transplant year, donor, conditioning intensity, sex matching, interval diagnosis-relapse and relapse-allogeneic HCT as compared to chemotherapy consolidation. Similarly, risks of events in leukemia free survival and graft versus host disease, relapse free survival were higher with prior autologous HCT, 1.17 (1.01-1.35), p=0.03 and 1.18 (1.03-1.35) p= 0.02, respectively. Risk of death was also higher 1.13 (0.97-1.32) p=0.1 but this was not significant. Post remission consolidation with autologous HCT for AML in CR1 increases toxicity of subsequent allogeneic HCT in CR2.

KEYWORDS:

AML autologous consolidation; subsequent allogeneic HCT; toxicity

PMID:
31759159
DOI:
10.1016/j.bbmt.2019.11.021

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