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JCO Oncol Pract. 2020 Jan 27:JOP1900133. doi: 10.1200/JOP.19.00133. [Epub ahead of print]

Rapid Donor Identification Improves Survival in High-Risk First-Remission Patients With Acute Myeloid Leukemia.

Author information

1
Swedish Cancer Institute, Seattle, WA.
2
Fred Hutchinson Cancer Research Center, Seattle, WA.
3
MD Anderson Cancer Center, Houston, TX.
4
Ohio State University, Columbus, OH.
5
Vanderbilt Ingram Cancer Center, Nashville, TN.
6
Mayo Clinic, Rochester, MN.
7
Tom Baker Cancer Centre, Calgary, Alberta, Canada.
8
Center for International Blood and Marrow Transplant Research, Minneapolis, MN.
9
National Marrow Donor Program, Minneapolis, MN.
10
Stanford University, Stanford, CA.
11
Cleveland Clinic, Cleveland, OH.
12
University of Kansas, Westwood, KS.
13
Washington University School of Medicine, St Louis, MO.
14
Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC.
15
Monter Cancer Center, Northwell Health System, Lake Success, NY.
16
University of Chicago, Chicago, IL.
17
Dana-Farber Cancer Institute, Boston, MA.
18
Pennsylvania State Milton S. Hershey Medical Center, Hershey, PA.
19
Jewish Hospital, Cincinnati, OH.
20
University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA.
21
SWOG Statistical Center, Seattle, WA.
22
Duke University Medical Center, Durham, NC.

Abstract

PURPOSE:

Patients with acute myeloid leukemia with high-risk cytogenetics in first complete remission (CR1) achieve better outcomes if they undergo allogeneic hematopoietic cell transplantation (HCT) compared with consolidation chemotherapy alone. However, only approximately 40% of such patients typically proceed to HCT.

METHODS:

We used a prospective organized approach to rapidly identify donors to improve the allogeneic HCT rate in adults with high-risk acute myeloid leukemia in CR1. Newly diagnosed patients had cytogenetics obtained at enrollment, and those with high-risk cytogenetics underwent expedited HLA typing and were encouraged to be referred for consultation with a transplantation team with the goal of conducting an allogeneic HCT in CR1.

RESULTS:

Of 738 eligible patients (median age, 49 years; range, 18-60 years of age), 159 (22%) had high-risk cytogenetics and 107 of these patients (67%) achieved CR1. Seventy (65%) of the high-risk patients underwent transplantation in CR1 (P < .001 compared with the historical rate of 40%). Median time to HCT from CR1 was 77 days (range, 20-356 days). In landmark analysis, overall survival (OS) among patients who underwent transplantation was significantly better compared with that of patients who did not undergo transplantation (2-year OS, 48% v 35%, respectively [P = .031]). Median relapse-free survival after transplantation in the high-risk cohort who underwent transplantation in CR1 (n = 70) was 11.5 months (range, 4-47 months), and median OS after transplantation was 14 months (range, 4-44 months).

CONCLUSION:

Early cytogenetic testing with an organized effort to identify a suitable allogeneic HCT donor led to a CR1 transplantation rate of 65% in the high-risk group, which, in turn, led to an improvement in OS when compared with the OS of patients who did not undergo transplantation.

PMID:
32048933
DOI:
10.1200/JOP.19.00133

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