title: Evaluation of allogeneic hematopoietic SCT in younger adults with adverse karyotype AML.
abstract: To illustrate methodological issues, we compared donor vs no-donor to transplant vs no-transplant comparisons in a cohort of 107 patients aged 50 years with adverse karyotype AML in first CR. Adverse karyotypes were defined as -7, del(7q), -5, del(5q), t(9;22), 11q23, 3q26 or complex abnormalities. Mantel-Byar estimations and hematopoietic SCT (HSCT) as a time-dependent variable were used to compare transplant vs no-transplant cumulative incidence of relapse (CIR), relapse-free survival (RFS) and OS. In all, 52 patients had a sibling donor, but only 35 of them were transplanted in first CR, whereas 9 patients received HSCT from alternative stem cell sources. Donor-based analysis showed lower CIR in the donor group, not translating in prolonged RFS or OS. Conversely, transplant-based analysis showed that HSCT in the first CR improved the three CIR (multivariate hazard ratio (HR), 0.31; P<0.001), RFS (multivariate HR, 0.57; P=0.047) and OS (multivariate HR, 0.54; P=0.03) endpoints. At 5 years, OS was estimated at 33% in transplanted vs 18% in non-transplanted patients. The positive effect of HSCT was more pronounced in patients aged 35 years and/or in those transplanted in the more recent years. These results confirm that HSCT is likely the best curative option in younger patients with adverse karyotype AML.
authors.affiliation: Department of Haematology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris 7, Paris, France.
authors.forename: M A
authors.initials: MA
authors.lastname: Hospital
authors.forename: X
authors.initials: X
authors.lastname: Thomas
authors.forename: S
authors.initials: S
authors.lastname: Castaigne
authors.forename: E
authors.initials: E
authors.lastname: Raffoux
authors.forename: C
authors.initials: C
authors.lastname: Pautas
authors.forename: C
authors.initials: C
authors.lastname: Gardin
authors.forename: J-H
authors.initials: JH
authors.lastname: Bourhis
authors.forename: O
authors.initials: O
authors.lastname: Reman
authors.forename: T
authors.initials: T
authors.lastname: de Revel
authors.forename: C
authors.initials: C
authors.lastname: Terré
authors.forename: C
authors.initials: C
authors.lastname: Preudhomme
authors.forename: P
authors.initials: P
authors.lastname: Fenaux
authors.forename: M
authors.initials: M
authors.lastname: Michallet
authors.forename: G
authors.initials: G
authors.lastname: Socié
authors.forename: H
authors.initials: H
authors.lastname: Dombret
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000235:genetics* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous; D055815:Young Adult