Hematopoietic stem-cell transplantation for acute leukemia in relapse or primary induction failure.
OBJECTIVE
Patients with acute leukemia refractory to induction or reinduction chemotherapy have poor prognoses if they do not undergo hematopoietic stem-cell transplantation (HSCT). However, HSCT when a patient is not in complete remission (CR) is of uncertain benefit. We hypothesized that pretransplantation variables may define subgroups that have a better prognosis.


METHODS
Overall, 2,255 patients who underwent transplantation for acute leukemia in relapse or with primary induction failure after myeloablative conditioning regimen between 1995 and 2004 were reported to the Center for International Blood and Marrow Transplant Research. The median follow-up of survivors was 61 months. We performed multivariate analysis of pretransplantation variables and developed a predictive scoring system for survival.


RESULTS
The 3-year overall survival (OS) rates were 19% for acute myeloid leukemia (AML) and 16% for acute lymphoblastic leukemia (ALL). For AML, five adverse pretransplantation variables significantly influenced survival: first CR duration less than 6 months, circulating blasts, donor other than HLA-identical sibling, Karnofsky or Lansky score less than 90, and poor-risk cytogenetics. For ALL, survival was worse with the following: first refractory or second or greater relapse, > or = 25% marrow blasts, cytomegalovirus-seropositive donor, and age of 10 years or older. Patients with AML who had a predictive score of 0 had 42% OS at 3 years, whereas OS was 6% for a score > or = 3. Patients with ALL who had a score of 0 or 1 had 46% 3-year OS but only 10% OS rate for a score > or = 3.


CONCLUSIONS
Pretransplantation variables delineate subgroups with different outcomes. HSCT during relapse can achieve long-term survival in selected patients with acute leukemia.
Duval
Michel
M
Centre Hospitalier Universitaire Sainte-Justine, Universite de Montreal, Montreal, Canada.
Klein
John P
JP
He
Wensheng
W
Cahn
Jean-Yves
JY
Cairo
Mitchell
M
Camitta
Bruce M
BM
Kamble
Rammurti
R
Copelan
Edward
E
de Lima
Marcos
M
Gupta
Vikas
V
Keating
Armand
A
Lazarus
Hillard M
HM
Litzow
Mark R
MR
Marks
David I
DI
Maziarz
Richard T
RT
Rizzieri
David A
DA
Schiller
Gary
G
Schultz
Kirk R
KR
Tallman
Martin S
MS
Weisdorf
Daniel
D
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D016019:Survival Analysis; D019172:Transplantation Conditioning; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult