Extramedullary disease at diagnosis of AML does not influence outcome of patients undergoing allogeneic hematopoietic cell transplant in CR1

• Published in: European journal of haematology Vol. 99; no. 3; pp. 234 - 239
• Main Authors: Bourlon, Christianne, Lipton, Jeffrey H., Deotare, Uday, Gupta, Vikas, Kim, Dennis D., Kuruvilla, John, Viswabandya, Auro, Thyagu, Santhosh, Messner, Hans A., Michelis, Fotios V.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-09-2017
• Subjects: Acute myeloid leukemia; Adolescent; Adult; Aged; allogeneic hematopoietic cell transplant; Central nervous system; Chemotherapy; Diagnosis; extramedullary; Female; Gingiva; Graft vs Host Disease - etiology; Graft vs Host Disease - prevention & control; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Humans; Leukemia; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - pathology; Leukemia, Myeloid, Acute - therapy; Male; Middle Aged; Multivariate analysis; Myeloid leukemia; Neoplasm Staging; Prognosis; Recurrence; Remission; Sarcoma, Myeloid - mortality; Sarcoma, Myeloid - pathology; Sarcoma, Myeloid - therapy; Skin; Studies; Survival Analysis; Transplantation; Transplantation Conditioning; Transplantation, Homologous; Transplants & implants; Treatment Outcome; Young Adult; acute myeloid leukemia; allogeneic hematopoietic cell transplant; extramedullary
• ISSN: 0902-4441; 1600-0609
• DOI: 10.1111/ejh.12909

Objective
Extramedullary disease (EMD) at diagnosis of acute myeloid leukemia (AML) has been associated with increased risk of relapse and worse outcomes post‐chemotherapy. This study sought to investigate the association of EMD with outcomes following allogeneic hematopoietic cell transplantation (allo‐HCT).
Methods
This single‐center retrospective study investigated the impact of EMD at diagnosis on the outcome of patients transplanted for AML in first complete remission (CR1). The study included 303 consecutive patients with AML transplanted in CR1, median age 51 years (range 18‐71).
Results
EMD at diagnosis was documented in 39 patients (13%), either histologically (26 patients) or clinically/radiologically (13 patients). Among the 39 EMD patients, 16 had CNS disease, seven had gingival infiltration, and five had leukemia cutis. On univariate analysis, EMD had no significant impact on survival, with a 3‐year OS of 55% (95% CI 38‐69) compared to 48% for the non‐EMD group (95% CI 42%‐55%) (P=.84). Likewise, 3‐year CIR was 18% vs 19% (P=.86) and 3‐year NRM was 26% vs 33% (P=.83) for EMD vs non‐EMD groups, respectively. Multivariate analysis confirmed these results.
Conclusions
We conclude that EMD at diagnosis of AML does not seem to influence outcomes following allo‐HCT performed in CR1.