Predictive value of karyotype on outcome of autotransplants for acute myeloid leukemia in second remission.
The impact of karyotype on the outcome of patients who undergo autotransplant for acute myeloid leukemia (AML) in second remission (CR2) has not been explored. We evaluated the outcomes of 40 patients who proceeded to autotransplant for AML in CR2 at 2 centers. The median age at autotransplant was 50 years (18-64 years) and the median duration of first remission was 15 months (0.8-51 months). High-dose therapy was melphalan 140-160 mg/m2 plus etoposide 60 mg/kg with or without total body irradiation (22), a busulfan-based regimen (17), and cyclophosphamide alone (1). Six patients (15%) died of treatment-related causes within the first 100 days. Event-free and overall survival at 3 years were both 38% (95% confidence interval 23-53%). At a median follow-up of 76 months (2?-?170) in surviving patients, 13 (32.5%) are alive and disease free. Graft purging did not significantly influence survival outcome (P=0.94), although platelet engraftment was significantly delayed (P=0.02). The relative risk of an event (relapse or death) for the karyotype risk groups was favorable 1.0; intermediate 4.2 (1.2-14.7); adverse 9.9 (1.5-63.9); unknown 2.3 (0.6-8.8) (P=0.028). We conclude that patients with AML in CR2 who undergo autotransplant can have durable remissions and those with a good risk karyotype are the most likely to obtain long-term disease-free survival.
Song
Kevin W
KW
The Leukemia/Bone Marrow Transplantation Program of British Columbia, Vancouver Hospital and Health Sciences Center, British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada. ksong@bccancer.bc.ca
Mollee
Peter N
PN
Hogge
Donna E
DE
Gupta
Vikas
V
Barnett
Michael J
MJ
Forrest
Donna L
DL
Lavoie
Julye C
JC
Nevill
Thomas J
TJ
Nantel
Stephen H
SH
Shepherd
John D
JD
Smith
Clay A
CA
Sutherland
Heather J
HJ
Toze
Cynthia L
CL
Crump
Michael
M
Keating
Armand
A
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007621:Karyotyping; D007951:Leukemia, Myeloid / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D014182:Transplantation, Autologous; D017211:Treatment Failure; D016896:Treatment Outcome; D014916:Whole-Body Irradiation