title: 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.
abstract: 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.
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California 91010, USA. hfung@coh.org
authors.forename: H C
authors.initials: HC
authors.lastname: Fung
authors.forename: A
authors.initials: A
authors.lastname: Stein
authors.forename: M l
authors.initials: Ml
authors.lastname: Slovak
authors.forename: M R
authors.initials: MR
authors.lastname: O'donnell
authors.forename: D S
authors.initials: DS
authors.lastname: Snyder
authors.forename: S
authors.initials: S
authors.lastname: Cohen
authors.forename: D
authors.initials: D
authors.lastname: Smith
authors.forename: A
authors.initials: A
authors.lastname: Krishnan
authors.forename: R
authors.initials: R
authors.lastname: Spielberger
authors.forename: R
authors.initials: R
authors.lastname: Bhatia
authors.forename: S
authors.initials: S
authors.lastname: Bhatia
authors.forename: P
authors.initials: P
authors.lastname: Falk
authors.forename: A
authors.initials: A
authors.lastname: Molina
authors.forename: A
authors.initials: A
authors.lastname: Nademanee
authors.forename: P
authors.initials: P
authors.lastname: Parker
authors.forename: R
authors.initials: R
authors.lastname: Rodriguez
authors.forename: J
authors.initials: J
authors.lastname: Rosenthal
authors.forename: R
authors.initials: R
authors.lastname: Sweetman
authors.forename: N
authors.initials: N
authors.lastname: Kogut
authors.forename: F
authors.initials: F
authors.lastname: Sahebi
authors.forename: L
authors.initials: L
authors.lastname: Popplewell
authors.forename: N
authors.initials: N
authors.lastname: Vora
authors.forename: G
authors.initials: G
authors.lastname: Somlo
authors.forename: K
authors.initials: K
authors.lastname: Margolin
authors.forename: W
authors.initials: W
authors.lastname: Chow
authors.forename: E
authors.initials: E
authors.lastname: Smith
authors.forename: S J
authors.initials: SJ
authors.lastname: Forman
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D020732:Cytogenetic Analysis; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome