title: Factors predicting outcome after allogeneic transplant in refractory acute myeloid leukemia: a retrospective analysis of Gruppo Italiano Trapianto di Midollo Osseo (GITMO).
abstract: The clinical outcome of primary refractory (PRF) AML patients is poor and only a minor proportion of patients is rescued by allogenic hematopoietic stem cell transplantation (HSCT). The identification of pre-HSCT variables may help to determine PRF AML patients who can most likely benefit from HSCT. We analyzed PRF AML patients transplanted between 1999 and 2012 from a sibling, unrelated donor or a cord blood unit. Overall, 227 patients from 26 Gruppo Italiano Trapianto di Midollo Osseo e Terapia cellulare centers were included in the analysis. At 3 years, the overall survival was 14%. By multivariate analysis, the number of chemotherapy cycles, (hazard ratio (HR): 1.87; 95% confidence interval (CI): 1.24-2.85; P=0.0028), the percentage of bone marrow or peripheral blood blasts (HR: 1.75; 95% CI: 1.16-2.64; P=0.0078), the adverse cytogenetic (HR: 1.44; 95% CI: 1.00-2.07; P=0.0508) and the age of patients (HR: 1.77; 95% CI: 1.08-2.88; P=0.0223) remained significantly associated with survival. Thus, we set up a new score predicting at 3 years after transplantation, an overall survival probability of 32% for patients with score 0 (no or 1 prognostic factor), 10% for patients with score 1 (2 prognostic factors) and 3% for patients with score 2 (3 or 4 prognostic factors).
authors.affiliation: Department of Hematology and Oncology, Humanitas Cancer Center, Rozzano-Milano, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Todisco
authors.affiliation: Hematology and BMT Unit, San Raffaele Scientific Institute, Milano, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ciceri
authors.affiliation: Hematology and BMT Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Boschini
authors.affiliation: Hematology and BMT Unit, San Raffaele Scientific Institute, Milano, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Giglio
authors.affiliation: Hematology and BMT Unit, Catholic University, Policlinico A. Gemelli, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bacigalupo
authors.affiliation: Hematology and BMT Unit, Azienda Ospedaliera Universitaria Ospedale Santa Maria della Misericordia, Udine, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Patriarca
authors.affiliation: Department of Hematology, BMT Unit, Univeristy of Firenze, Firenze, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Donnini
authors.affiliation: Department of Hematology Oncology, IRCCS Fondazione Policlinico San Matteo &University of Pavia, Pavia, Italy.
authors.forename: E P
authors.initials: EP
authors.lastname: Alessandrino
authors.affiliation: Hematology and Stem Cell Transplant Unit, Policlinico Tor Vergata, Rome, Italy.
authors.forename: W
authors.initials: W
authors.lastname: Arcese
authors.affiliation: Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy.
authors.forename: A P
authors.initials: AP
authors.lastname: Iori
authors.affiliation: Department of Hematology Oncology, Ospedale Niguarda Ca' Granda, Milano, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Marenco
authors.affiliation: Hematology and BMT Unit, Ospedale Generale Regionale di Bolzano, Bolzano, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Cavattoni
authors.affiliation: Hematology and BMT Unit, Catholic University, Policlinico A. Gemelli, Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Chiusolo
authors.affiliation: Department of Clinical Medicine and Prevention, University of Milano Bicocca, Monza, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Terruzzi
authors.affiliation: Department of Hematology and Oncology, Humanitas Cancer Center, Rozzano-Milano, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Castagna
authors.affiliation: Department of Hematology and Oncology, Humanitas Cancer Center, Rozzano-Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Department of Hematology, BMT Unit, Univeristy of Firenze, Firenze, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bosi
authors.affiliation: Hematology and BMT Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Oldani
authors.affiliation: GITMO Data Center, IRCCS AOU San Martino, Genova, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Bruno
authors.affiliation: Bologna University, S. Orsola-Malpighi Hospital-Institute of Hematology &Medical Oncology L &A Seràgnoli, Bologna, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bonifazi
authors.affiliation: Hematology and BMT Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Rambaldi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D035781:Siblings; D015996:Survival Rate; D061349:Unrelated Donors