Allogeneic hematopoietic cell transplant for AML: no impact of pre-transplant extramedullary disease on outcome.
The impact of extramedullary disease (EMD) in AML on the outcomes of allogeneic hematopoietic cell transplantation (alloHCT) is unknown. Using data from the Center for International Blood and Marrow Transplant Research, we compared the outcomes of patients who had EMD of AML at any time before transplant, with a cohort of AML patients without EMD. We reviewed data from 9797 AML patients including 814 with EMD from 310 reporting centers and 44 different countries, who underwent alloHCT between and 1995 and 2010. The primary outcome was overall survival (OS) after alloHCT. Secondary outcomes included leukemia-free survival (LFS), relapse rate and treatment-related mortality (TRM). In a multivariate analysis, the presence of EMD did not affect either OS (hazard ratio 1.00, 95% confidence interval (CI) 0.91-1.09), LFS (0.98, 0.89-1.09), TRM (relative risk 0.92, 95% CI 0.80-1.16, P=0.23) or relapse (relative risk=1.03, 95% CI, 0.92-1.16; P=0.62). Furthermore, the outcome of patients with EMD was not influenced by the location, timing of EMD, or intensity of conditioning regimen. The presence of EMD in AML does not affect transplant outcomes and should not be viewed as an independent adverse prognostic feature.
St Louis University Medical Center, St Louis, MO, USA.
S D
SD
Goyal
1] Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA [2] Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
M-J
MJ
Zhang
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
H-L
HL
Wang
Section of Hematology Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ, USA.
G
G
Akpek
Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA.
E A
EA
Copelan
South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
C
C
Freytes
Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK.
R P
RP
Gale
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
M
M
Hamadani
National Cancer Center Hospital, Tokyo, Japan.
Y
Y
Inamoto
Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA.
R T
RT
Kamble
Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
H M
HM
Lazarus
Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK.
D I
DI
Marks
Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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0000000226217924
T
Nishihori
1] Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden [2] Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
R F
RF
Olsson
Department of Medicine, Abramson Cancer Center, University of Pennsylvania Medical Center, Philadelphia, PA, USA.
R
R
Reshef
Royal Melbourne Hospital, Melbourne, VIC, Australia.
D S
DS
Ritchie
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
W
W
Saber
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
B N
BN
Savani
Hospital Samaritano, Sao Paulo, Brazil.
A
A
Seber
Division of Hematology and Oncology, Department of Medicine, University of North Carolina Health Care, Chapel Hill, NC, USA.
T C
TC
Shea
Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
M S
MS
Tallman
Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
B
B
Wirk
Department of Internal Medicine III, Universitätsklinikum Ulm, Ulm, Germany.
D W
DW
Bunjes
Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center-James, Columbus, OH, USA.
S M
SM
Devine
Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
M
M
de Lima
Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA.
D J
DJ
Weisdorf
Department of Medicine, Washington University School of Medicine, St Louis, MO, USA.
G L
GL
Uy
D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy; D008577:Meningeal Neoplasms / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000401:mortality / Q000628:therapy; D023981:Sarcoma, Myeloid / Q000401:mortality / Q000628:therapy; D012878:Skin Neoplasms / Q000401:mortality / Q000628:therapy