title: Achievement of complete remission predicts outcome of allogeneic haematopoietic stem cell transplantation in patients with chronic myelomonocytic leukaemia. A study of the Chronic Malignancies Working Party of the European Group for Blood and Marrow Transplantation.
abstract: The results of allogeneic stem cell transplantation (allo-SCT) in chronic myelomonocytic leukaemia (CMML) are usually reported together with other categories of myelodysplastic syndrome. We analysed transplantation outcome in 513 patients with CMML, with a median age of 53 years reported to the European Group for Blood and Marrow Transplantation. Conditioning was standard (n = 249) or reduced-intensity (n = 226). Donors were human leucocyte antigen-related (n = 285) or unrelated (n = 228). Disease status at transplantation was complete remission (CR) in 122 patients, no CR in 344, and unknown in 47. Engraftment was successful in 95%. Grades 2-4 acute graft-versus-host disease (GvHD) occurred in 33% of the patients and chronic GvHD was reported in 24%. The 4-year cumulative incidence of non-relapse mortality was 41% and 32% for relapse, resulting in a 4-year estimated relapse-free and overall survival (OS) of 27% and 33%, respectively. Patients transplanted in CR had lower probability for non-relapse death (P = 0·002) and longer relapse-free and OS (P = 0·001 and P = 0·005, respectively). In multivariate analysis the only significant prognostic factor for survival was the presence of CR at transplantation (P = 0·005). Allo-SCT remains a curative treatment option for patients with CMML and should preferably be performed early after diagnosis or after establishing the best possible remission status.
authors.affiliation: Haematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece.
authors.forename: Argiris
authors.initials: A
authors.lastname: Symeonidis
authors.affiliation: Department of Medical Statistics & Bioinformatics, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Anja
authors.initials: A
authors.lastname: van Biezen
authors.affiliation: Department of Medical Statistics & Bioinformatics, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Liesbeth
authors.initials: L
authors.lastname: de Wreede
authors.affiliation: GIMEMA Data Centre, Rome, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Piciocchi
authors.affiliation: Department of Medicine, Haematology, Oncology, University of Freiburg, Freiburg, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Finke
authors.affiliation: Department of Bone Marrow Transplantation, University Hospital, Essen, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Beelen
authors.affiliation: Medizinische Klinik und Poliklinik I, Universitätsklinikum Technische Universität Dresden, Dresden, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bornhäuser
authors.affiliation: Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, the Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Cornelissen
authors.affiliation: Stem Cell Transplantation Unit, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Liisa
authors.initials: L
authors.lastname: Volin
authors.affiliation: Department of Haematological Medicine, GKT School of Medicine, London, UK.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Mufti
authors.affiliation: Département des Spécialités de Médecine Service d'Hématologie, Hôpitaux Universitaires de Genève, and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Yves
authors.initials: Y
authors.lastname: Chalandon
authors.affiliation: Department of Haematology, Haemostasis and Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
authors.forename: Arnold
authors.initials: A
authors.lastname: Ganser
authors.affiliation: Division of Haematology, Città della Salute e della Scienza di Torino, Torino, Italy.|Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.affiliation: Division of Haematology, Oncology and Haemostasiology, University of Leipzig, Leipzig, Germany.
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.affiliation: Department for Haematology, Oncology and Clinical Immunology, University Hospital Dusseldorf, Heinrich Heine University, Dusseldorf, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Kobbe
authors.affiliation: Deutsche Klinik fur Diagnostik, KMT Zentrum, Wiesbaden, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Schwerdtfeger
authors.affiliation: Department of Tumourimmunology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: de Witte
authors.affiliation: Department of Haematology and BMT, Hopital Saint Louis, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.affiliation: Department of Stem Cell Transplantation, University Medical Centre Hamburg, Hamburg, Germany.
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
keywords: WHO classification; allogeneic stem cell transplantation; chronic myelomonocytic leukaemia; prognosis; survival