title: Comparative analysis of the value of allogeneic hematopoietic stem-cell transplantation in acute myeloid leukemia with monosomal karyotype versus other cytogenetic risk categories.
abstract: OBJECTIVE
  To determine to what extent allogeneic hematopoietic stem-cell transplantation (alloHSCT) quantitatively reduces relapse in acute myeloid leukemia with monosomal karyotype (MK-AML) compared with alternative postremission therapy and how it compares with other cytogenetic subcategories.
  
  
  METHODS
  Of 2,560 patients (younger than age 61 years) without core-binding factor abnormalities including 305 patients with MK-AML receiving first-line induction treatment, 1,975 patients (77%) achieved remission, and 1,588 received consolidation in the first complete remission (CR1) after two induction cycles. Consolidation treatment of 107 patients with MK-AML consisted of alloHSCT (n = 45), chemotherapy (n = 48), or autologous HSCT (n = 14).
  
  
  RESULTS
  The 5-year overall survival after start of consolidation was 19% for patients with MK-AML who received alloHSCT and 9% for those who received chemotherapy or autoHSCT (P = .02). Relapse-free survival (RFS) at 5 years was 17% versus 7% (P = .003). Cox regression analysis was performed with alloHSCT as a time-dependent covariate. Hazard ratios (HRs) associated with alloHSCT for relapse and RFS were 0.30 (95% CI, 0.24 to 0.37; P < .001), and 0.52 (95% CI, 0.43 to 0.62; P < .001), respectively. HRs were similar in MK-AML and the other cytogenetic subgroups.
  
  
  CONCLUSIONS
  AlloHSCT, applied as consolidation in CR1, is associated with a significant reduction of relapse and improvement of survival in MK-AML, with the same relative reduction of relapse or death as in other cytogenetic risk categories.
authors.affiliation: Erasmus University Medical Center, Rotterdam, the Netherlands. j.cornelissen@erasmusmc.nl
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Cornelissen
authors.forename: Dimitri
authors.initials: D
authors.lastname: Breems
authors.forename: Wim L J
authors.initials: WL
authors.lastname: van Putten
authors.forename: Alois A
authors.initials: AA
authors.lastname: Gratwohl
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Passweg
authors.forename: Thomas
authors.initials: T
authors.lastname: Pabst
authors.forename: Johan
authors.initials: J
authors.lastname: Maertens
authors.forename: H Berna
authors.initials: HB
authors.lastname: Beverloo
authors.forename: Marinus
authors.initials: M
authors.lastname: van Marwijk Kooy
authors.forename: Pierre W
authors.initials: PW
authors.lastname: Wijermans
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Biemond
authors.forename: Edo
authors.initials: E
authors.lastname: Vellenga
authors.forename: Leo F
authors.initials: LF
authors.lastname: Verdonck
authors.forename: Gert J
authors.initials: GJ
authors.lastname: Ossenkoppele
authors.forename: Bob
authors.initials: B
authors.lastname: Löwenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D003582:Cytogenetics / Q000379:methods*; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000235:genetics* / Q000628:therapy*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D014184:Transplantation, Homologous; D016896:Treatment Outcome