Validation of a Predictive Model for Survival in Patients with Acute Myeloid Leukemia and Myelodysplastic Syndrome Receiving Hematopoietic Stem Cell Transplantation
Background: Outcomes of allogeneic stem cell transplantation (AHSCT) vary based on both disease and patient characteristics. Our group developed a model to predict survival in patients with AML/MDS using 3 factors, 2 disease-related (cytogenetics, disease status at transplant) and 1 patient-related (HCT-CI) (Bachegowda et al.Blood.2017). This model effectively stratified patients into 3 risk groups with very different survival. Here we aim to validate this model in a large cohort of AML/MDS patients receiving AHSCT with different donors.
We report a retrospective analysis of outcomes of therapy of 24 patients with AML or MDS-EB refractory to high dose salvage chemotherapy or who had failed previous HCT, who received T cell replete HLA haploidentical HCT in aplasia after cladribine/cytarabine based chemotherapy followed by reduced intensity or myeloablative conditioning. All patients had active disease before commencement of the treatment.Results91.7% of patients achieved CR, whereas 2 patients (8.2%) died in aplasia. 1-year relapse rate was 49.3%. Cumulative incidence of non-relapse mortality (NRM) was 25.6%. In a subgroup of patients with HCT-CI score
ppe Rossi Considerable progress has been made in the treatment of acute myeloid leukemia (AML). However, current therapeutic results are still unsatisfactory in untreated high-risk patients and poorer in those with primary refractory or relapsed disease. In older patients, reluctance by clinicians to treat unfit patients, higher AML cell resistance related to more frequent adverse karyotype and/or precedent myelodysplastic syndrome, and preferential involvement of chemorefractory early hemopoietic precursors in the pathogenesis of the disease further account for poor prognosis, with median survival lower than six month...
Publication date: Available online 8 February 2019Source: Best Practice &Research Clinical HaematologyAuthor(s): Alfred Chung, Michaela LiedtkeAbstractTherapy-related myeloid neoplasms (t-MN), including therapy-related acute myeloid leukaemia and myelodysplastic syndrome, are second primary malignancies (SPM) that are of growing importance as patients with plasma cell disorders (PCD) such as multiple myeloma (MM) are living longer with more effective therapies. Both patient-specific and treatment-specific factors likely impact the risk of t-MN development after diagnosis and treatment of PCD. Alkylating chemotherapy, e...
Purpose of review Myelodysplastic syndromes (MDS) are a diverse group of clonal disorders of hematopoietic stem or progenitor cells that represent the most common class of acquired bone marrow failure syndromes in adults. Despite significant improvement in the pathologic insight into this group of disorders, therapeutic options remain limited and allogeneic hematopoietic stem-cell transplantation is the only treatment that can induce long-term remission in patients with MDS. The goals of therapy for MDS are based on disease prognostication, with a focus of minimizing transfusion dependence and preserving quality of life ...
Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) is briefly defined as an AML which have multilineage dysplasia (MLD), a history of myelodysplastic syndrome (MDS) and/or an MDS-related cytogenetic abnormalities. Recent study showed that AML-MRC exhibits a worse clinical outcome than AML not otherwise specified (AML-NOS). Though allogenic hematopoietic stem cell transplantation (allo-SCT) is believed to improve the outcome of AML-MRC, few reports had referred to its benefit. The purpose of this study was to clarify the outcome and the prognostic factors of patients (pts) with AML-MRC who underwent allo-SCT.
Allogeneic hematopoietic stem cells transplant (HSCT) is a curative treatment for acute myeloid leukemia (AML). The persistence of disease-associated somatic mutations following HSCT for myelodysplastic syndrome has been shown to be associated with a high risk of disease progression. While a recent study in AML found that the presence of somatic mutations at day 21 post-HSCT is associated with higher risk of relapse, there is paucity of data at a later time point. We hypothesized that persistence of mutations at day 100 resulted in increased relapse rates and inferior outcomes than in patients who had cleared their mutations.
In patients with poor risk AML or MDS in first complete remission (CR1), alloSCT can be potentially curative. Comparison of the non-hematologic toxicities between total body irradiation (TBI)-based conditioning versus chemotherapy alone prior to CD34-selected alloSCT requires further validation.
Reduced-intensity conditioning (RIC) regimens have expanded allogeneic hematopoietic stem cell transplantation (allo-HSCT) to patients (pts) with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) who are unfit for myeloablative regimens. Several RIC regimens are typically used. We and others have previously shown that fludarabine-melphalan (FM) has a lower risk of relapse compared to fludarabine-busulfan (FB).
Allogeneic hematopoietic stem cell transplantation (HCT) remains a challenge in elderly and comorbid AML and MDS patients. This patient population is at increased risk for non-relapse mortality (NRM) when treated with standard myeloablative conditioning and was selected to compare a newly developed treosulfan-based with a well-established reduced intensity busulfan-based preparative regimen in a prospective randomized clinical phase III trial.
Conclusions: The low to medium doses of ATG may be associated with improving survival outcomes and reducing incidence of ecGVHD without enhancing the chances of relapse in patients with acute leukemia or myelodysplastic syndrome undergoing non-TBI-based HLA-mismatched allogeneic HSCT. PMID: 30616303 [PubMed - as supplied by publisher]