A long-term follow-up report on allogeneic stem cell transplantation for patients with primary refractory acute myelogenous leukemia: impact of cytogenetic characteristics on transplantation outcome

• Published in: Biology of blood and marrow transplantation Vol. 9; no. 12; pp. 766 - 771
• Main Authors: Fung, H.C, Stein, A, Slovak, M.L, O’Donnell, M.R, Snyder, D.S, Cohen, S, Smith, D, Krishnan, A, Spielberger, R, Bhatia, R, Bhatia, S, Falk, P, Molina, A, Nademanee, A, Parker, P, Rodriguez, R, Rosenthal, J, Sweetman, R, Kogut, N, Sahebi, F, Popplewell, L, Vora, N, Somlo, G, Margolin, K, Chow, W, Smith, E, Forman, S.J
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2003
• Subjects: Acute myelogenous leukemia; Adolescent; Adult; Allogeneic stem cell transplantation; Bone Marrow Transplantation - mortality; Child; Child, Preschool; Cytogenetic Analysis; Cytogenetic characteristics; Female; Follow-Up Studies; Hematopoietic Stem Cell Transplantation - mortality; Humans; Leukemia, Myeloid, Acute - diagnosis; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - therapy; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Factors; Salvage Therapy; Survival Analysis; Transplantation, Homologous; Treatment failure; Treatment Outcome; Treatment failure; Acute myelogenous leukemia; Cytogenetic characteristics; Allogeneic stem cell transplantation
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2003.08.004

The prognosis of patients with primary refractory acute myelogenous leukemia (AML) is poor. Our initial report suggested that some patients could achieve durable remission after allogeneic stem cell transplantation (SCT). Herein, we update our initial experience and report further analysis of this group of patients to determine whether there are pre-SCT prognostic factors predictive of posttransplantation relapse and survival. We reviewed the records of 68 patients who consecutively underwent transplantation at the City of Hope Cancer Center with allogeneic SCT for primary refractory AML between July 1978 and August 2000. Potential factors associated with overall survival and disease-free survival were examined. With a median follow-up of 3 years, the 3-year cumulative probabilities of disease-free survival (DFS), overall survival (OS), and relapse rate for all 68 patients were 31% (95% confidence interval [CI], 20%–42%), 30% (95% CI, 18%–41%), and 51% (95% CI, 38%–65%), respectively. In multivariate analysis, the only variables associated with shortened OS and DFS included the use of an unrelated donor as the stem cell source (relative risk, 2.23 [OS] and 2.05 [DFS];
P = .0005 and .0014, respectively) and unfavorable cytogenetics before SCT (relative risk: 1.68 [OS] and 1.58 [DFS];
P = .0107 and .0038, respectively). Allogeneic SCT can cure approximately one third of patients with primary refractory AML. Cytogenetic characteristics before SCT correlate with transplantation outcome and posttransplantation relapse.