title: Hematologic Recovery after Pretransplant Chemotherapy Does Not Influence Survival after Allogeneic Hematopoietic Cell Transplantation in Acute Myeloid Leukemia Patients.
abstract: Pretransplant remission status in patients with acute myeloid leukemia (AML) is 1 of the most important factors determining their outcomes after allogeneic hematopoietic cell transplantation (allo-HCT). Most patients are in complete remission with full hematologic recovery (CR) before undergoing allo-HCT. However, some patients achieve CR without recovery of platelet count (CRp) or a morphologic leukemia-free state (MLFS), defined as meeting all CR criteria without recovery of both neutrophil and platelet counts. Currently, there is a paucity of data regarding transplant outcomes in AML patients achieving MLFS after chemotherapy. To address this question, we evaluated transplant outcomes in 270 AML patients who received 6/6 HLA-matched sibling or 10/10 HLA-matched unrelated donor transplantation at a single institution between 2006 and 2013. Of our 270 patients, 206 were in CR, 45 were in CRp, and 19 were in MLFS before allo-HCT. Patients in CR, CRp, or MLFS had similar 3-year overall survival rates (49%, 46%, and 47%, respectively; P = .88) and 3-year event-free survival rates (45%, 36%, and 40%, respectively; P = .53). However, the cumulative incidence of nonrelapse mortality was significantly higher in patients in MLFS compared with those in CR (58% versus 22%, P = .0004), whereas the cumulative incidence of relapse in patients in MLFS was significantly lower compared with those in CR (11% versus 36%, P = .03). Our results suggest that survival outcomes in AML patients are not influenced by degree of hematologic recovery before allo-HCT.
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Khoan
authors.initials: K
authors.lastname: Vu
authors.affiliation: Department of Hospital Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Shivaprasad
authors.initials: S
authors.lastname: Manjappa
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: John F
authors.initials: JF
authors.lastname: DiPersio
authors.affiliation: Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Peter
authors.initials: P
authors.lastname: Westervelt
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Ravi
authors.initials: R
authors.lastname: Vij
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Keith E
authors.initials: KE
authors.lastname: Stockerl-Goldstein
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Uy
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Camille N
authors.initials: CN
authors.lastname: Abboud
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schroeder
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Fehniger
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Cashen
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri. Electronic address: rromee@dom.wustl.edu.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Romee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006402:Hematologic Diseases / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019172:Transplantation Conditioning / Q000379:methods* / Q000401:mortality; D014184:Transplantation, Homologous / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult
keywords: AML; Complete remission; Hematologic recovery; Morphologic leukemia-free state; Pretransplantation remission status; Transplantation
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