- Title
- Unrelated donor allogeneic transplantation after failure of autologous transplantation for acute myelogenous leukemia: a study from the Center for International Blood and Marrow Transplantation Research
- Creator
- Foran, James M.; Pavletic, Steven Z.; Copelan, Edward A.; Dehn, Jason; Gale, Robert P.; George, Biju; Gupta, Vikas; Hale, Gregory A.; Lazarus, Hillard M.; Litzow, Mark R.; Maharaj, Dipnarine; Marks, David I.; Logan, Brent R.; Martino, Rodrigo; Maziarz, Richard T.; Rowe, Jacob M.; Rowlings, Philip A.; Savani, Bipin N.; Savoie, Mary Lynn; Szer, Jeffrey; Waller, Edmund K.; Wiernik, Peter H.; Weisdorf, Daniel J.; Agovi-Johnson, Manza A.; Perez, Waleska S.; Bolwell, Brian J.; Bornhaeuser, Martin; Bredeson, Christopher N.; Cairo, Mitchell S.; Camitta, Bruce M.
- Relation
- Biology of Blood and Marrow Transplantation Vol. 19, Issue 7, p. 1102-1108
- Publisher Link
- http://dx.doi.org/10.1016/j.bbmt.2013.04.022
- Publisher
- Elsevier
- Resource Type
- journal article
- Date
- 2013
- Description
- The survival of patients with relapsed acute myelogenous leukemia (AML) after autologous hematopoietic stem cell transplantation (auto-HCT) is very poor. We studied the outcomes of 302 patients who underwent secondary allogeneic hematopoietic cell transplantation (allo-HCT) from an unrelated donor (URD) using either myeloablative (n = 242) or reduced-intensity conditioning (RIC; n = 60) regimens reported to the Center for International Blood and Marrow Transplantation Research. After a median follow-up of 58 months (range, 2 to 160 months), the probability of treatment-related mortality was 44% (95% confidence interval [CI], 38%-50%) at 1-year. The 5-year incidence of relapse was 32% (95% CI, 27%-38%), and that of overall survival was 22% (95% CI, 18%-27%). Multivariate analysis revealed a significantly better overal survival with RIC regimens (hazard ratio [HR], 0.51; 95% CI, 0.35-0.75; P <.001), with Karnofsky Performance Status score ≥90% (HR, 0.62; 95% CI, 0.47-0.82: P = .001) and in cytomegalovirus-negative recipients (HR, 0.64; 95% CI, 0.44-0.94; P = .022). A longer interval (>18 months) from auto-HCT to URD allo-HCT was associated with significantly lower riak of relapse (HR, 0.19; 95% CI, 0.09-0.38; P <.001) and improved leukemia-free survival (HR, 0.53; 95% CI, 0.34-0.84; P = .006). URD allo-HCT after auto-HCT relapse resulted in 20% long-term leukemia-free survival, with the best results seen in patients with a longer interval to secondary URD transplantation, with a Karnofsky Performance Status score ≥90%, in complete remission, and using an RIC regimen. Further efforts to reduce treatment-related mortaility and relapse are still needed.
- Subject
- acute myelogenous leukemia; unrelated donor; transplantation; allogeneic; autologous
- Identifier
- http://hdl.handle.net/1959.13/1300516
- Identifier
- uon:20099
- Identifier
- ISSN:1083-8791
- Language
- eng
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