Long-term survival and late events after allogeneic stem cell transplantation from HLA-matched siblings for acute myeloid leukemia with myeloablative compared to reduced-intensity conditioning: a report on behalf of the acute leukemia working party of European group for blood and marrow transplantation
Por:
Shimoni, A, Labopin, M, Savani, B, Volin, L, Ehninger, G, Kuball, J, Bunjes, D, Schaap, N, Vigouroux, S, Bacigalupo, A, Veelken, H, Sierra, J, Eder, M, Niederwieser, D, Mohty, M, Nagler, A
Publicada:
8 nov 2016
Resumen:
Background: Myeloablative (MAC) and reduced-intensity conditioning (RIC) are established approaches for allogeneic stem cell transplantation (SCT) in acute myeloid leukemia (AML). Most deaths after MAC occur within the first 2 years after SCT, while patients surviving leukemia-free for 2 years can expect a favorable long-term outcome. However, there is paucity of data on the long-term outcome (beyond 10 years) and the pattern of late events following RIC due to the relative recent introduction of this approach.
Methods: We analyzed long-term outcomes in a cohort of 1423 AML patients, age >= 50 years, after SCT from HLA-matched siblings, during the years 1997-2005, median follow-up 8.3 years (0.1-17).
Results: The 10-year leukemia-free survival (LFS) was 31 % (95CI, 27-35) and 32 % (28-35) after MAC and RIC, respectively (P = 0.57). The 10-year GVHD/relapse-free survival (GRFS), a surrogate for quality of life was 22 % (18-25) and 21 % (18-24), respectively (P = 0.79). The 10-year non-relapse mortality (NRM) was higher and relapse rate was lower after MAC, throughout the early and late post-transplant course. The 10-year LFS among 584 patients surviving leukemia-free 2 years after SCT was 71 % (65-76) and 73 % (67-78) after MAC and RIC, respectively (P = 0.76). Advanced leukemia at SCT was the major predictor of LFS subsequent to the 2-year landmark. Relapse was the major cause of late death after both regimens; however, NRM and in particular chronic graft-versus-host disease and second cancers were more common causes of late death after MAC.
Conclusions: Long-term LFS and GRFS are similar after RIC and MAC. Most events after RIC or MAC occur within the first 2 years after SCT. Patients who are leukemia-free 2 years after SCT can expect similar good subsequent outcome after both approaches.
Filiaciones:
Shimoni, A:
Tel HaShomer & Tel Aviv Univ, Chaim Sheba Med Ctr, Dept Bone Marrow Transplantat, Tel Aviv, Israel
Labopin, M:
Hop St Antoine, ALWP Off, Serv Hematol & Therapie Cellulaire, Paris, France
Savani, B:
Vanderbilt Univ Hematol & Transplantat, Nashville, TN USA
Volin, L:
HUCH Comprehens Canc Ctr, Stem Cell Transplantat Unit, Helsinki, Finland
Ehninger, G:
Univ Klinikum Dresden, Med Klin & Poliklin 1, Dresden, Germany
Kuball, J:
Univ Med Ctr, Dept Haematol, Utrecht, Netherlands
Bunjes, D:
Univ Ulm Klinikum, Innere Med Klin 3, Ulm, Germany
Schaap, N:
Nijmegen Med Ctr, Dept Haematol, Nijmegen, Netherlands
Vigouroux, S:
CHU Bordeaux, Hop Haut leveque, Pessac, France
Bacigalupo, A:
Osped San Martino Genova, Dept Haematol 2, Genoa, Italy
Veelken, H:
Leiden Univ Hosp, BMT Ctr Leiden, Leiden, Netherlands
Sierra, J:
Hosp Santa Creu & Sant Pau, Dept Hematol, IIB St Pau & Josep Carreras Leukemia Res Inst, Barcelona, Spain
Eder, M:
Hannover Med Sch, Dept Haematol Hemostasis Oncol & Stem Cell Transp, Hannover, Germany
Niederwieser, D:
Univ Hosp Leipzig, Div Haematol & Oncol, Leipzig, Germany
Mohty, M:
Hop St Antoine, ALWP Off, Serv Hematol & Therapie Cellulaire, Paris, France
Nagler, A:
Tel HaShomer & Tel Aviv Univ, Chaim Sheba Med Ctr, Dept Bone Marrow Transplantat, Tel Aviv, Israel
Hop St Antoine, ALWP Off, Serv Hematol & Therapie Cellulaire, Paris, France
Gold, Green Published
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