Prognostic factors for outcomes of patients with refractory or relapsed acute myelogenous leukemia or myelodysplastic syndromes undergoing allogeneic progenitor cell transplantation.
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.
Wong
Raymond
R
Department of Blood and Marrow Transplantation, University of Texas M.D Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
Shahjahan
Munir
M
Wang
Xuemei
X
Thall
Peter F
PF
De Lima
Marcos
M
Khouri
Issa
I
Gajewski
James
J
Alamo
Jorge
J
Couriel
Daniel
D
Andersson
Borje S
BS
Donato
Michelle
M
Hosing
Chitra
C
Komanduri
Krishna
K
Anderlini
Paolo
P
Molldrem
Jeffrey
J
Ueno
Naoto T
NT
Estey
Elihu
E
Ippoliti
Cindy
C
Champlin
Richard
R
Giralt
Sergio
S
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