title: Duration of first remission, hematopoietic cell transplantation-specific comorbidity index and patient age predict survival of patients with AML transplanted in second CR.
abstract: Allo-SCT is potentially curative for patients with AML. Patients transplanted in CR2 tend to experience inferior survival compared with those in CR1. We retrospectively investigated the impact of pretransplant variables on the outcome of patients transplanted with AML in CR2. Ninety-four patients with AML in CR2 received a transplant between 1999 and 2011 with myeloablative (MA, n=65) or reduced-intensity conditioning regimens (RIC, n=29). Variables investigated included cytogenetic risk at diagnosis (SWOG), hematopoietic cell transplantation-specific comorbidity index (HCT-CI), CMV status, duration of CR1 and age. Median age of all patients was 47 years (range 18-70). Multivariable analysis for OS identified three prognostically significant categories: a favorable risk group included patients with duration of CR1 ≥6 months, age <55 years and HCT-CI score 0-3, an intermediate risk group with duration of CR1 ≥6 months, age <55 years and HCT-CI score 4-5 and a high-risk group with duration of CR1 <6 months or age ≥55 years (P=0.0001) with 5-year survivals of 53%, 31% and 6%, respectively. Acute and chronic GVHD did not influence this risk stratification. The stated risk factors discriminate patients with different OS and may assist in decision making for allo-SCT.
authors.affiliation: Allogeneic Blood and Marrow Transplant Program, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: F V
authors.initials: FV
authors.lastname: Michelis
authors.forename: E G
authors.initials: EG
authors.lastname: Atenafu
authors.forename: V
authors.initials: V
authors.lastname: Gupta
authors.forename: D D
authors.initials: DD
authors.lastname: Kim
authors.forename: J
authors.initials: J
authors.lastname: Kuruvilla
authors.forename: A
authors.initials: A
authors.lastname: Lambie
authors.forename: J H
authors.initials: JH
authors.lastname: Lipton
authors.forename: D
authors.initials: D
authors.lastname: Loach
authors.forename: H A
authors.initials: HA
authors.lastname: Messner
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D016019:Survival Analysis; D014019:Tissue Donors; D055815:Young Adult