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Biol Blood Marrow Transplant. 2018 Aug;24(8):1754-1758. doi: 10.1016/j.bbmt.2018.03.025. Epub 2018 Apr 9.

Allogeneic Hematopoietic Stem Cell Transplantation Following the Use of Hypomethylating Agents among Patients with Relapsed or Refractory AML: Findings from an International Retrospective Study.

Author information

1
Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, Connecticut.
2
Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
3
Department of Medicine, Hospital Universitario y Politécnico de La Fe, University of Valencia, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain.
4
Saint-Louis Hospital, University Paris 7, Paris, France.
5
Division of Hematology and Oncology, Weill Cornell Medicine and The New York Presbyterian Hospital.
6
Leukemia Program, Cleveland Clinic, Cleveland, Ohio.
7
Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.
8
Department of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
9
Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
10
Division of Hematology, Mayo Clinic, Rochester, Minnesota.
11
Côte d'Azur University, Nice Sophia Antipolis University, CHU of Nice, Nice, France; INSERM U1065, Mediterranean Center of Molecular Medicine, Nice, France.
12
Division of Hematology, University of Florence, Florence, Italy.
13
Department of Pharmacy, Yale New Haven Hospital, New Haven, Connecticut.
14
Department of Hematology, Institut Paoli Calmettes, Marseille, France.
15
Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
16
Division of Hematology/Oncology, Hospital San Pedro Alcántara, Cáceres, Spain.
17
Division of Hematology/Oncology, University Hospital Reina Sofía, Cordoba, Spain.
18
Department of Internal Medicine, Section of Hematology, Yale University School of Medicine, New Haven, Connecticut. Electronic address: amer.zeidan@yale.edu.

Abstract

Patients with primary refractory or relapsed acute myeloid leukemia (RR-AML) have very poor prognosis. Due to limited treatment options, some patients are treated with hypomethylating agents (HMAs) due to their tolerability. Little is known about the role of allogeneic hematopoietic stem cell transplantation (HSCT) following HMA therapy in this setting. We retrospectively analyzed an international cohort of 655 RR-AML patients who received HMA therapy to study patterns and outcomes with HSCT. Only 37 patients (5.6%) patients underwent HSCT after HMA therapy. The conditioning regimen was myeloablative in 57% and nonmyeloablative in 43%. Patients received matched unrelated donor, matched sibling, haploidentical and mismatched unrelated HSCT in 56%, 24%, 16% and 4% of cases, respectively. Acute GvHD and chronic GvHD were observed in 40% and 17% of patients. While the median OS for the entire cohort of patients was 15.3 months (95% CI 9.5 - 21.7 months), OS reached 29.7 months (95% CI 7.01 - not-reached) for patients who achieved a complete remission (CR) to HMA and no intervening therapies between HMA therapy and HSCT. Our study suggests that HMA therapy can effectively bridge some patients with RR-AML to HSCT.

KEYWORDS:

AML; Hypomethylating agents; Survival; Transplant

PMID:
29649620
DOI:
10.1016/j.bbmt.2018.03.025

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