title: Early versus late preemptive allogeneic hematopoietic cell transplantation for relapsed or refractory acute myeloid leukemia.
abstract: Many patients with relapsed or refractory acute myeloid leukemia (AML) do not receive allogeneic hematopoietic cell transplantation (alloHCT) because they are unable to achieve a complete remission (CR) after reinduction chemotherapy. Starting in January 2003, we prospectively assigned patients with AML with high-risk clinical features to preemptive alloHCT (p-alloHCT) as soon as possible after reinduction chemotherapy. High-risk clinical features were associated with poor response to chemotherapy: primary induction failure, second or greater relapse, and first CR interval <6 months. We hypothesized that any residual disease would be maximally reduced at the time of transplant, resulting in the best milieu and most lead time for developing a graft-versus-leukemia effect and in improved long-term overall survival (OS) without excess toxicity. This analysis studied the effect of transplant timing on p-alloHCT in 30 patients with high-risk clinical features of 156 consecutive AML patients referred for alloHCT. We compared early p-alloHCT within 4 weeks of reinduction chemotherapy before count recovery with late p-alloHCT 4 weeks after reinduction chemotherapy with count recovery. OS and progression-free survival (PFS) at 2 years were not significantly different for early versus late p-alloHCT (OS 23% versus 33%, respectively, P > .1; PFS 18% versus 22%, respectively, P > .1). Day 100 and 1-year transplant-related mortality were similar (33.3% versus 22.2%, P > .1; 44.4% versus 42.9%, P > .1, respectively). Preemptive alloHCT allowed 30 patients to be transplanted who would normally not receive alloHCT. Clinical outcomes for early p-alloHCT are similar to those for late p-alloHCT without excess toxicity. Early p-alloHCT is a feasible alternative to late p-alloHCT for maximizing therapy of AML that is poorly responsive to induction chemotherapy.
authors.affiliation: Department of Medicine, BMT Program, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: George L
authors.initials: GL
authors.lastname: Chen
authors.affiliation: Department of Medicine, BMT Program, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Hong
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Medicine, BMT Program, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Yali
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Medicine, BMT Program, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Julie
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Department of Medicine, BMT Program, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Maureen
authors.initials: M
authors.lastname: Ross
authors.affiliation: Department of Medicine, Leukemia Division, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Eunice S
authors.initials: ES
authors.lastname: Wang
authors.affiliation: Clinical Cytogenetics Laboratory, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: AnneMarie W
authors.initials: AW
authors.lastname: Block
authors.affiliation: Clinical Cytogenetics Laboratory, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Sheila
authors.initials: S
authors.lastname: Sait
authors.affiliation: Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: George
authors.initials: G
authors.lastname: Deeb
authors.affiliation: Department of Flow Cytometry, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Wallace
authors.affiliation: Department of Medicine, Leukemia Division, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Meir
authors.initials: M
authors.lastname: Wetzler
authors.affiliation: Department of Medicine, BMT Program, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Theresa
authors.initials: T
authors.lastname: Hahn
authors.affiliation: Department of Medicine, BMT Program, Roswell Park Cancer Institute, Buffalo, New York. Electronic address: philip.mccarthy@RoswellPark.org.
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D014184:Transplantation, Homologous / Q000009:adverse effects*; D055815:Young Adult
keywords: Allogeneic hematopoietic cell transplant; Hypoplasia; Relapsed or refractory AML