title: Salvage therapy for acute chemorefractory leukemia by allogeneic stem cell transplantation: the Korean experience.
abstract: Little is known about the characteristics that make patients with acute leukemia suitable for undergoing salvage therapy by allogeneic hematopoietic stem cell transplantation (allo-HSCT). Here, we analyzed the clinical outcomes of 223 patients with acute leukemia who underwent allo-HSCT while not in complete remission (CR). The primary end points were overall survival (OS) and CR rate. CR was achieved in 79.8% of patients after allo-HSCT. Acute graft-versus-host disease (GVHD) was significantly associated with CR (P = 0.045). During a median follow-up of 30.1 months, the median OS was 6.1 months. OS was significantly longer in patients with good or standard risk cytogenetic characteristics than in those with poor risk cytogenetic characteristics (P = 0.029, P = 0.030, respectively). Patients who received allo-HSCT from a matched sibling donor had better survival than those with unrelated donors (P = 0.015). Primary chemorefractoriness was not associated with poor survival (P = 0.071). The number of chemotherapies before allo-HSCT was significantly correlated with outcome (P = 0.006). Chronic GVHD was a strong predictor of a longer OS (P = 0.025). In conclusion, survival of patients with primary chemorefractory acute leukemia is not lower when treated upfront with allo-HSCT. Hence, allo-HSCT should be actively considered in such patients. Acute and chronic GVHD is associated with better outcomes patients with acute leukemia who have undergone allo-HSCT and not achieved CR.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea.
authors.forename: Shin Hye
authors.initials: SH
authors.lastname: Yoo
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea.
authors.forename: Youngil
authors.initials: Y
authors.lastname: Koh
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Dae-Young
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Jung-Hee
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Je-Hwan
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Kyoo-Hyung
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea.
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea.
authors.forename: Seonyang
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea.
authors.forename: Sung-Kyu
authors.initials: SK
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea.
authors.forename: Dae-Sik
authors.initials: DS
authors.lastname: Hong
authors.affiliation: Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea.
authors.forename: Hyeon Gyu
authors.initials: HG
authors.lastname: Yi
authors.affiliation: Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea.
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Yonsei University Severance Hospital, 250 Sungsan-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, Yonsei University Severance Hospital, 250 Sungsan-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
authors.forename: June-Won
authors.initials: JW
authors.lastname: Cheong
authors.affiliation: Department of Internal Medicine, Kyung-Pook University Hospital, Daegu, South Korea.
authors.forename: Joonho
authors.initials: J
authors.lastname: Moon
authors.affiliation: Department of Internal Medicine, Yonsei University Severance Hospital, 250 Sungsan-ro, Seodaemun-gu, Seoul, 120-752, South Korea. minbrmmd@yuhs.ac.
authors.forename: Yoo Hong
authors.initials: YH
authors.lastname: Min
authors.affiliation: Department of Internal Medicine, Kyung-Pook University Hospital, Daegu, South Korea. sksohn@knu.ac.kr.|Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 200 Dongduk-ro, Jung-gu, Daegu, 700-721, South Korea. sksohn@knu.ac.kr.
authors.forename: Sang Kyun
authors.initials: SK
authors.lastname: Sohn
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea. ihkimmd@snu.ac.kr.
authors.forename: Inho
authors.initials: I
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007938:Leukemia / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods* / Q000401:mortality; D015996:Survival Rate / Q000639:trends; D014184:Transplantation, Homologous
keywords: Acute leukemia; Allogeneic hematopoietic stem cell transplantation; Chemorefractoriness; Graft-versus-host disease