title: Prognostic factors for outcomes of patients with refractory or relapsed acute myelogenous leukemia or myelodysplastic syndromes undergoing allogeneic progenitor cell transplantation.
abstract: Allogeneic progenitor cell transplantation is the only curative therapy for patients with refractory acute myelogenous leukemia or myelodysplastic syndromes. To identify prognostic factors in these patients, we performed a retrospective analysis of transplantation outcomes. Patients were selected if they had undergone an allogeneic transplantation between January 1988 and January 2002 and were not in remission or first untreated relapse at the time of transplantation. A total of 135 patients were identified. The median age was 49.5 years (range, 19-75 years). At the time of transplantation, 39.3% of patients had not responded to induction therapy, 37% had not responded to first salvage therapy, and 23.7% were beyond first salvage. Forty-one patients (30%) received unrelated donor progenitor cells. Eighty patients (59%) received either a reduced-intensity or a nonmyeloablative regimen. A total of 104 (77%) of 135 patients died, with a median survival time of 4.9 months (95% confidence interval, 3.9-6.6 months). The median progression-free survival was 2.9 months (95% confidence interval, 2.5-4.2 months). A Cox regression analysis showed that Karnofsky performance status, peripheral blood blasts, and tacrolimus exposure during the first 11 days after transplantation were predictive of survival. These data support the use of allogeneic transplantation for patients with relapsed or refractory acute myelogenous leukemia/myelodysplastic syndromes and suggest that optimal immune suppression early after transplantation is essential for long-term survival even in patients with refractory myeloid leukemias.
authors.affiliation: Department of Blood and Marrow Transplantation, University of Texas M.D Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
authors.forename: Raymond
authors.initials: R
authors.lastname: Wong
authors.forename: Munir
authors.initials: M
authors.lastname: Shahjahan
authors.forename: Xuemei
authors.initials: X
authors.lastname: Wang
authors.forename: Peter F
authors.initials: PF
authors.lastname: Thall
authors.forename: Marcos
authors.initials: M
authors.lastname: De Lima
authors.forename: Issa
authors.initials: I
authors.lastname: Khouri
authors.forename: James
authors.initials: J
authors.lastname: Gajewski
authors.forename: Jorge
authors.initials: J
authors.lastname: Alamo
authors.forename: Daniel
authors.initials: D
authors.lastname: Couriel
authors.forename: Borje S
authors.initials: BS
authors.lastname: Andersson
authors.forename: Michelle
authors.initials: M
authors.lastname: Donato
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Krishna
authors.initials: K
authors.lastname: Komanduri
authors.forename: Paolo
authors.initials: P
authors.lastname: Anderlini
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Molldrem
authors.forename: Naoto T
authors.initials: NT
authors.lastname: Ueno
authors.forename: Elihu
authors.initials: E
authors.lastname: Estey
authors.forename: Cindy
authors.initials: C
authors.lastname: Ippoliti
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
mesh_terms: D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome