title: Outcome of conditioning intensity in acute myeloid leukemia with monosomal karyotype in patients over 45 year-old: A study from the acute leukemia working party (ALWP) of the European group of blood and marrow transplantation (EBMT).
abstract: Acute myeloid leukemia with monosomal karyotype (MK AML) carries a very poor prognosis, even after allogeneic stem cell transplantation (SCT). However, SCT remains the only curative option in this high-risk population. Because myeloablative conditioning regimen (MAC) is associated with less relapse, we hypothesized that more intensive conditioning regimen might be beneficial for MK AML patients. We reviewed 303 patients over age 45 diagnosed with either de novo or secondary MK AML. One hundred and five patients received a MAC and 198 a reduced-intensity conditioning (RIC). The median age at SCT was 57-year-old, significantly lower in the MAC (53-year-old) than in the RIC group (59-year-old). The median follow-up was 42 months (range, 3 - 156 months). The 3-year overall survival (OS), leukemia-free survival (LFS), and relapse rate (RR) were not significantly different between both groups with overall values of 34%, 29%, and 51%, respectively. On the contrary, the 3-year nonrelapse mortality (NRM) was significantly higher in MAC recipients (28%) compared with RIC patients (16%, P = 0.004). The incidence of Grades II to IV acute graft-versus-host disease (GvHD) was significantly higher after a MAC (30.5%) than after a RIC (19.3%, P = 0.02). That of chronic GvHD was comparable between both groups (35%) and did not impact on LFS. Interestingly, within our MK AML cohort, hypodiploidy was significantly associated with worse outcomes. Due to reduced toxicity and comparable OS, LFS, and RR, RIC appears as a good transplant option in the very high-risk population, including older patients, diagnosed with MK AML.
authors.affiliation: Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Xavier
authors.initials: X
authors.lastname: Poiré
authors.affiliation: EBMT Pris Study Office/CEREST-TC, Paris, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.affiliation: Section of Hematology, Erasmus MC-Daniel Den Hoed Cancer Centre, Rotterdam, The Netherlands.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Cornelissen
authors.affiliation: Section of Hematology, Helsinki University Central Hospital, Helsinki, Sweden.
authors.forename: Liisa
authors.initials: L
authors.lastname: Volin
authors.affiliation: Section of Hematology, Hospital U. Marques De Valdecilla, Santander, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Richard Espiga
authors.affiliation: Section of Hematology, Leiden University Hospital, Leiden, The Netherlands.
authors.forename: J Hendrik
authors.initials: JH
authors.lastname: Veelken
authors.affiliation: Section of Hematology, CHU Bordeaux, Pessac, France.
authors.forename: Noël
authors.initials: N
authors.lastname: Milpied
authors.affiliation: Section of Hematology, Hôpital a Michallon, Grenoble, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Cahn
authors.affiliation: Section of Hematology, Hôpital Huriez, Lille, France.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yacoub-Agha
authors.affiliation: Section of Hematology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Gustaaf W
authors.initials: GW
authors.lastname: van Imhoff
authors.affiliation: Section of Hematology, Centre Hospitalier Lyon Sud, Lyon, France.
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.affiliation: Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Lucienne
authors.initials: L
authors.lastname: Michaux
authors.affiliation: Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
authors.affiliation: Section of Hematology, Hôpital Saint-Antoine, Paris, France.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
mesh_terms: D000208:Acute Disease; D000368:Aged; D002908:Chronic Disease; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009006:Monosomy; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D011379:Prognosis; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D014184:Transplantation, Homologous
chemical_list: D019653:Myeloablative Agonists