title: Reduced intensity conditioning for allogeneic hematopoietic stem cell transplantation in patients with acute myeloid leukemia: disease status by marrow blasts is the strongest prognostic factor.
abstract: We analyzed predictive factors for the outcome of 113 acute myeloid leukemia patients receiving reduced-intensity conditioning prior to allogeneic hematopoietic stem cell transplantation (HSCT). Patients were ineligible for conventional-intensity HSCT. Conditioning consisted of fludarabine and 50% of the conventional dose of busulfan (n=93) or total body irradiation (n=20). The source of stem cells was blood in 102 patients, marrow in 10, and both in one. In total, 50 (44.2%) donors were HLA-matched siblings, 50 (44.2%) unrelated fully matched and 13 (11.5%) partially mismatched family (n=1) or unrelated (n=12) donors. In all, 107 (94.6%) patients showed neutrophil and platelet engraftment after a median time of 13.5 and 13 days. The probabilities of event-free survival (EFS) (median follow-up: 12 months) were 49% for patients with less than 5% blasts in the marrow, 24% for patients with 5-20% blasts (P=0.002) and 14% with >20% blasts (P<or=0.001). Death occurred because of relapse in 29 patients (25.6%), infection in 12 patients (10.6%), acute graft-versus-host disease in eight patients (7.0%) and organ toxicity in nine patients (7.9%). In multivariate analysis, higher number of blasts in the marrow, alternative donors and low Karnofsky performance score were independent adverse prognostic factors for EFS.
authors.affiliation: Klinik und Poliklinik für Innere Medizin II, Friedrich-Schiller-Universität Jena, Germany.
authors.forename: H G
authors.initials: HG
authors.lastname: Sayer
authors.forename: M
authors.initials: M
authors.lastname: Kröger
authors.forename: J
authors.initials: J
authors.lastname: Beyer
authors.forename: M
authors.initials: M
authors.lastname: Kiehl
authors.forename: S A
authors.initials: SA
authors.lastname: Klein
authors.forename: K
authors.initials: K
authors.lastname: Schaefer-Eckart
authors.forename: R
authors.initials: R
authors.lastname: Schwerdtfeger
authors.forename: W
authors.initials: W
authors.lastname: Siegert
authors.forename: V
authors.initials: V
authors.lastname: Runde
authors.forename: C
authors.initials: C
authors.lastname: Theuser
authors.forename: H
authors.initials: H
authors.lastname: Martin
authors.forename: J
authors.initials: J
authors.lastname: Schetelig
authors.forename: D W
authors.initials: DW
authors.lastname: Beelen
authors.forename: A
authors.initials: A
authors.lastname: Fauser
authors.forename: J
authors.initials: J
authors.lastname: Kienast
authors.forename: K
authors.initials: K
authors.lastname: Höffken
authors.forename: G
authors.initials: G
authors.lastname: Ehninger
authors.forename: M
authors.initials: M
authors.lastname: Bornhäuser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005858:Germany / Q000453:epidemiology; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D014184:Transplantation, Homologous