title: Cytogenetics and outcome of allogeneic transplantation in first remission of acute myeloid leukemia: the French pediatric experience.
abstract: We analyzed the impact of cytogenetics on 193 children enrolled in two successive French trials (LAME89/91 and ELAM02), who received hematopoietic stem cell transplantation during CR1. Detailed karyotype was available for 66/74 (89%) in LAME89/91 and 118/119 (99%) in ELAM02. Several karyotype and transplant characteristics differed according to therapeutic protocol: unfavorable karyotypes were more frequent in ELAM02 (36% vs 18%), pretransplant chemotherapy included high-dose cytarabine in ELAM02 and not in LAME89/91, IV replaced oral busulfan in the conditioning regimen, methotrexate was removed from post-transplant immunosuppression, and matched unrelated donor and cord blood transplantation were introduced. Five-year overall survival (OS) was 78.2% in LAME89 and 81.4% in ELAM02. OS was significantly lower for the unfavorable cytogenetic risk group in LAME89/91 when compared with intermediate and favorable groups (50% vs 90.6 and 86.4%, P=0.001). This difference was no longer apparent in ELAM02 (80.9% vs 71.3% and 5/5, respectively). Survival improvement for children with unfavorable karyotype was statistically significant (P=0.026) and was due to decrease in relapse risk. Five-year transplantation-related mortality was 6.75% in LAME89/91. In ELAM02, it was 3.2% for patients with a sibling donor and 10.9% with an unrelated donor or cord blood. We conclude that the outcome of children with unfavorable karyotype transplanted in CR1 has improved.
authors.affiliation: Department of Pediatric Hematology and Oncology, Timone Enfants Hospital and Aix-Marseille University, Marseille, France.
authors.forename: A-L
authors.initials: AL
authors.lastname: Alloin
authors.affiliation: Department of Pediatric Hematology and Oncology, AP-HP, GH HUEP, Trousseau Hospital, Paris, France.|UPMC University Paris 6, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Leverger
authors.affiliation: Department of Pediatric Hematology and Oncology, Robert Debré Hospital, Paris, France.
authors.forename: J-H
authors.initials: JH
authors.lastname: Dalle
authors.affiliation: Department of Pediatric Hematology and Oncology, Timone Enfants Hospital and Aix-Marseille University, Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Galambrun
authors.affiliation: Department of Pediatric Hematology and Oncology, University Hospital of Lyon, Lyon, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Bertrand
authors.affiliation: Department of Pediatric Hematology and Oncology, Robert Debré Hospital, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Baruchel
authors.affiliation: Department of Pediatric Hematology and Oncology, AP-HP, GH HUEP, Trousseau Hospital, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Auvrignon
authors.affiliation: Department of Pediatric Hematology and Oncology, University Hospital of Rennes, Rennes, France.
authors.forename: V
authors.initials: V
authors.lastname: Gandemer
authors.affiliation: Department of Pediatric Hematology and Oncology, AP-HP, GH HUEP, Trousseau Hospital, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Ragu
authors.affiliation: Research Unit EA3279 and Department of Public Health, Aix-Marseille University and Timone Hospital Marseille, Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Loundou
authors.affiliation: Department of Genetics, St Antoine Hospital, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Bilhou-Nabera
authors.affiliation: Department of Genetics, Timone Enfants Hospital and Aix-Marseille University, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Lafage-Pochitaloff
authors.affiliation: Department of Genetics, University hospital of Toulouse, Toulouse, France.
authors.forename: N
authors.initials: N
authors.lastname: Dastugue
authors.affiliation: CHU Lille, Department of Pediatric Hematology and Oncology, Lille, France.
authors.forename: B
authors.initials: B
authors.lastname: Nelken
authors.affiliation: Department of Pediatric Hematology and Oncology, University Hospital of Bordeaux, Bordeaux, France.
authors.forename: C
authors.initials: C
authors.lastname: Jubert
authors.affiliation: Department of Pediatric Hematology and Oncology, University Hospital of Nantes, Nantes, France.
authors.forename: F
authors.initials: F
authors.lastname: Rialland
authors.affiliation: Department of Pediatric Hematology and Oncology, University Hospital of Toulouse, Toulouse, France.
authors.forename: G
authors.initials: G
authors.lastname: Plat
authors.affiliation: Department of Pediatric Hematology and Oncology, Hôpital d'Enfants de Brabois, Vandoeuvre Les Nancy, France.
authors.forename: C
authors.initials: C
authors.lastname: Pochon
authors.affiliation: Department of Pediatric Hematology and Oncology, University Hospital of Rouen, Rouen, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Vannier
authors.affiliation: Department of Pediatric Hematology and Oncology, University Hospital L'Archet, Nice, France.
authors.forename: P-S
authors.initials: PS
authors.lastname: Rohrlich
authors.affiliation: Department of Pediatric Hematology and Oncology, CIC Inserm 501, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: J
authors.initials: J
authors.lastname: Kanold
authors.affiliation: Department of Pediatric Hematology and Oncology, Hospital University, Strasbourg, France.
authors.forename: P
authors.initials: P
authors.lastname: Lutz
authors.affiliation: Department of Pediatric Hematology and Oncology, University Hospital, Montpellier, France.
authors.forename: A
authors.initials: A
authors.lastname: Sirvent
authors.affiliation: Department of Pediatric Hematology and Oncology, Timone Enfants Hospital and Aix-Marseille University, Marseille, France.|Research Unit EA3279 and Department of Public Health, Aix-Marseille University and Timone Hospital Marseille, Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Oudin
authors.affiliation: Department of Cytogenetics, Saint-Louis Hospital, Paris, France.
authors.forename: W
authors.initials: W
authors.lastname: Cuccuini
authors.affiliation: Department of Pediatric Hematology and Oncology, Timone Enfants Hospital and Aix-Marseille University, Marseille, France.|Research Unit EA3279 and Department of Public Health, Aix-Marseille University and Timone Hospital Marseille, Marseille, France.
authors.forename: G
authors.initials: G
authors.lastname: Michel
mesh_terms: D002648:Child; D003582:Cytogenetics; D005260:Female; D005602:France; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000235:genetics* / Q000401:mortality / Q000628:therapy*; D008297:Male; D012074:Remission Induction; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome