A prospective registration study to determine feasibility of hematopoietic SCT in adults with acute leukemia: planning, expectations and reality.
For adults with acute leukemia, it is important to know whether the therapeutic schemes initially planned were actually implemented. The European Group for Blood and Marrow transplantation Acute Leukemia Working Party prospectively followed 695 consecutive patients who were registered at the time of HLA typing. Of 304 patients with an available matched sibling donor (MSD), SCT was planned in 264, chemotherapy in 33 and autografting in 7. For the rest, an unrelated donor (UD) search was initiated in 198. Among these, 117 were transplanted, 114 received chemotherapy and 77 underwent autografting. Probabilities of receiving a planned treatment were 60 and 65% at 1 and 2 years, respectively. Patients scheduled to receive MSD SCT had an 82% probability, whereas those scheduled to undergo UD SCT had a 57% probability, of receiving their transplant at 1 year. The only factor associated with a lower probability of MSD SCT in first remission was delayed HLA typing (HR=0.82; P=0.03). One year after enrollment, 40% of patients did not follow their initial treatment plan. Because OS was 50% only at 3 years and only 57% of the patients without a MSD underwent SCT, this suggests room for improvement in outcomes for adults with acute leukemia.
1] Paris EBMT Data Coordination Office, Hospital Saint-Antoine, APHP, Université Pierre et Marie Curie UPMC and INSERM U 938, Paris, France [2] Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris, France.
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Labopin
1] Paris EBMT Data Coordination Office, Hospital Saint-Antoine, APHP, Université Pierre et Marie Curie UPMC and INSERM U 938, Paris, France [2] Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris, France.
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Gorin
Paris EBMT Data Coordination Office, Hospital Saint-Antoine, APHP, Université Pierre et Marie Curie UPMC and INSERM U 938, Paris, France.
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Polge
Department of Hematology, APHP, Hospital Saint-Louis, University Paris VII, and Inserm U940, Paris, France.
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Socié
Department of Hematology, Adult Stem Cell Transplantation Unit, Ankara University School of Medicine, Ankara, Turkey.
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Gurman
Eurocord, Hospital Saint-Louis, Paris, France, and Haematology Department, Bone Marrow Transplant Unit, University of Oxford, Oxford, UK.
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Gluckman
Department of Hematology/Oncology, Charles University Hospital, Pilsen, Czech Republic.
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Jindra
Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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Poiré
Medizinische Klinik, BMT Unit, Nuremberg, Germany.
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Schäfer-Eckart
Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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Ruutu
Divisione Clinicizzata di Ematologia, BMT unit, Ospedale Ferrarotto, Catania, Italy.
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Milone
Stem Cell Transplant Unit, Rome Transplant Network, Tor Vergata University of Rome, Rome, Italy.
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Arcese
1] Paris EBMT Data Coordination Office, Hospital Saint-Antoine, APHP, Université Pierre et Marie Curie UPMC and INSERM U 938, Paris, France [2] Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris, France.
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Mohty
1] Paris EBMT Data Coordination Office, Hospital Saint-Antoine, APHP, Université Pierre et Marie Curie UPMC and INSERM U 938, Paris, France [2] Eurocord, Hospital Saint-Louis, Paris, France, and Haematology Department, Bone Marrow Transplant Unit, University of Oxford, Oxford, UK.
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Rocha
D000293:Adolescent; D000328:Adult; D000368:Aged; D018450:Disease Progression; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D006680:HLA Antigens / Q000737:chemistry; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011336:Probability; D011446:Prospective Studies; D012042:Registries; D012074:Remission Induction; D035781:Siblings; D016896:Treatment Outcome; D055815:Young Adult
D006680:HLA Antigens