Allogeneic Hematopoietic Cell Transplantation for Chronic Myelomonocytic Leukemia: Relapse-Free Survival Is Determined by Karyotype and Comorbidities

Hesham Eissa; Ted A. Gooley; Mohamed L. Sorror; Franchesca Nguyen; Bart L. Scott; Kristine Doney; Keith R. Loeb; Paul J. Martin; John M. Pagel; Jerry P. Radich; Brenda M. Sandmaier; E. Houston Warren; Rainer Storb; Frederick R. Appelbaum; H. Joachim Deeg

doi:10.1016/j.bbmt.2010.09.018

Allogeneic Hematopoietic Cell Transplantation for Chronic Myelomonocytic Leukemia: Relapse-Free Survival Is Determined by Karyotype and Comorbidities

Hesham Eissa, Ted A. Gooley, Mohamed L. Sorror, Franchesca Nguyen, Bart L. Scott, Kristine Doney, Keith R. Loeb, Paul J. Martin, John M. Pagel, Jerry P. Radich, Brenda M. Sandmaier, E. Houston Warren, Rainer Storb, Frederick R. Appelbaum, H. Joachim Deeg

Research output: Contribution to journal › Article › peer-review

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Abstract

Hematopoietic cell transplantation (HCT) offers potentially curative therapy for chronic myelomonocytic leukemia (CMML). We evaluated HCT outcomes in 85 patients with CMML, 1.0-69.1 (median 51.7) years of age, with follow-up extending to 19 years. CMML was considered de novo in 71 and secondary in 14 patients. Conditioning regimens were of various intensities. Thirty-eight patients had related (34 HLA identical), and 47 (39 HLA matched) unrelated donors. The source of stem cells was marrow in 32 and peripheral blood progenitor cells in 53 patients. Acute graft-versus-host disease (aGVHD) grades II-IV occurred in 72% and chronic GVHD (cGVHD) in 26% of patients. Relapse incidence was 27% at 10 years. Relapse correlated with increasing scores by the MD Anderson prognostic score (P = .01). The major causes of death were relapse and infections ±GVHD. Progression-free survival (PFS) was 38% at 10 years. Mortality was negatively correlated with pre-HCT hematocrit (P = .007), and increased with high-risk cytogenetics (P = .02), higher HCT Comorbidity Index (P = .0008), and increased age (P = .02). WHO classification did not statistically significantly affect outcome. Thus, a proportion of patients with CMML have lasting remissions following allogeneic HCT and appear to be cured of their disease.

Original language	English (US)
Pages (from-to)	908-915
Number of pages	8
Journal	Biology of Blood and Marrow Transplantation
Volume	17
Issue number	6
DOIs	https://doi.org/10.1016/j.bbmt.2010.09.018
State	Published - Jun 2011
Externally published	Yes

Bibliographical note

Funding Information:
The authors are grateful for research funding from the National Institutes of Health , Bethesda, MD, Grants P01HL036444, P01CA018029, P30CA015704 , and HL088021 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health nor its subsidiary Institutes and Centers. We thank all referring physicians for their continued support and all patients for participating in these trials. We are greatful to Joanne Greene, RN, Michelle Bouvier, RN, and Gary Schoch for data collection and management, and Helen Crawford and Bonnie Larson for help with manuscript preparation.

Keywords

CMML
Comorbidity
Cytogenetics
Hematopoietic cell transplantation

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10.1016/j.bbmt.2010.09.018

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Eissa, H., Gooley, T. A., Sorror, M. L., Nguyen, F., Scott, B. L., Doney, K., Loeb, K. R., Martin, P. J., Pagel, J. M., Radich, J. P., Sandmaier, B. M., Warren, E. H., Storb, R., Appelbaum, F. R., & Deeg, H. J. (2011). Allogeneic Hematopoietic Cell Transplantation for Chronic Myelomonocytic Leukemia: Relapse-Free Survival Is Determined by Karyotype and Comorbidities. Biology of Blood and Marrow Transplantation, 17(6), 908-915. https://doi.org/10.1016/j.bbmt.2010.09.018

Eissa, H, Gooley, TA, Sorror, ML, Nguyen, F, Scott, BL, Doney, K, Loeb, KR, Martin, PJ, Pagel, JM, Radich, JP, Sandmaier, BM, Warren, EH, Storb, R, Appelbaum, FR & Deeg, HJ 2011, 'Allogeneic Hematopoietic Cell Transplantation for Chronic Myelomonocytic Leukemia: Relapse-Free Survival Is Determined by Karyotype and Comorbidities', Biology of Blood and Marrow Transplantation, vol. 17, no. 6, pp. 908-915. https://doi.org/10.1016/j.bbmt.2010.09.018

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title = "Allogeneic Hematopoietic Cell Transplantation for Chronic Myelomonocytic Leukemia: Relapse-Free Survival Is Determined by Karyotype and Comorbidities",

abstract = "Hematopoietic cell transplantation (HCT) offers potentially curative therapy for chronic myelomonocytic leukemia (CMML). We evaluated HCT outcomes in 85 patients with CMML, 1.0-69.1 (median 51.7) years of age, with follow-up extending to 19 years. CMML was considered de novo in 71 and secondary in 14 patients. Conditioning regimens were of various intensities. Thirty-eight patients had related (34 HLA identical), and 47 (39 HLA matched) unrelated donors. The source of stem cells was marrow in 32 and peripheral blood progenitor cells in 53 patients. Acute graft-versus-host disease (aGVHD) grades II-IV occurred in 72% and chronic GVHD (cGVHD) in 26% of patients. Relapse incidence was 27% at 10 years. Relapse correlated with increasing scores by the MD Anderson prognostic score (P = .01). The major causes of death were relapse and infections ±GVHD. Progression-free survival (PFS) was 38% at 10 years. Mortality was negatively correlated with pre-HCT hematocrit (P = .007), and increased with high-risk cytogenetics (P = .02), higher HCT Comorbidity Index (P = .0008), and increased age (P = .02). WHO classification did not statistically significantly affect outcome. Thus, a proportion of patients with CMML have lasting remissions following allogeneic HCT and appear to be cured of their disease.",

keywords = "CMML, Comorbidity, Cytogenetics, Hematopoietic cell transplantation",

author = "Hesham Eissa and Gooley, {Ted A.} and Sorror, {Mohamed L.} and Franchesca Nguyen and Scott, {Bart L.} and Kristine Doney and Loeb, {Keith R.} and Martin, {Paul J.} and Pagel, {John M.} and Radich, {Jerry P.} and Sandmaier, {Brenda M.} and Warren, {E. Houston} and Rainer Storb and Appelbaum, {Frederick R.} and Deeg, {H. Joachim}",

note = "Funding Information: The authors are grateful for research funding from the National Institutes of Health , Bethesda, MD, Grants P01HL036444, P01CA018029, P30CA015704 , and HL088021 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health nor its subsidiary Institutes and Centers. We thank all referring physicians for their continued support and all patients for participating in these trials. We are greatful to Joanne Greene, RN, Michelle Bouvier, RN, and Gary Schoch for data collection and management, and Helen Crawford and Bonnie Larson for help with manuscript preparation. ",

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T2 - Relapse-Free Survival Is Determined by Karyotype and Comorbidities

AU - Eissa, Hesham

AU - Gooley, Ted A.

AU - Sorror, Mohamed L.

AU - Nguyen, Franchesca

AU - Scott, Bart L.

AU - Doney, Kristine

AU - Loeb, Keith R.

AU - Martin, Paul J.

AU - Pagel, John M.

AU - Radich, Jerry P.

AU - Sandmaier, Brenda M.

AU - Warren, E. Houston

AU - Storb, Rainer

AU - Appelbaum, Frederick R.

AU - Deeg, H. Joachim

N1 - Funding Information: The authors are grateful for research funding from the National Institutes of Health , Bethesda, MD, Grants P01HL036444, P01CA018029, P30CA015704 , and HL088021 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health nor its subsidiary Institutes and Centers. We thank all referring physicians for their continued support and all patients for participating in these trials. We are greatful to Joanne Greene, RN, Michelle Bouvier, RN, and Gary Schoch for data collection and management, and Helen Crawford and Bonnie Larson for help with manuscript preparation.

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N2 - Hematopoietic cell transplantation (HCT) offers potentially curative therapy for chronic myelomonocytic leukemia (CMML). We evaluated HCT outcomes in 85 patients with CMML, 1.0-69.1 (median 51.7) years of age, with follow-up extending to 19 years. CMML was considered de novo in 71 and secondary in 14 patients. Conditioning regimens were of various intensities. Thirty-eight patients had related (34 HLA identical), and 47 (39 HLA matched) unrelated donors. The source of stem cells was marrow in 32 and peripheral blood progenitor cells in 53 patients. Acute graft-versus-host disease (aGVHD) grades II-IV occurred in 72% and chronic GVHD (cGVHD) in 26% of patients. Relapse incidence was 27% at 10 years. Relapse correlated with increasing scores by the MD Anderson prognostic score (P = .01). The major causes of death were relapse and infections ±GVHD. Progression-free survival (PFS) was 38% at 10 years. Mortality was negatively correlated with pre-HCT hematocrit (P = .007), and increased with high-risk cytogenetics (P = .02), higher HCT Comorbidity Index (P = .0008), and increased age (P = .02). WHO classification did not statistically significantly affect outcome. Thus, a proportion of patients with CMML have lasting remissions following allogeneic HCT and appear to be cured of their disease.

AB - Hematopoietic cell transplantation (HCT) offers potentially curative therapy for chronic myelomonocytic leukemia (CMML). We evaluated HCT outcomes in 85 patients with CMML, 1.0-69.1 (median 51.7) years of age, with follow-up extending to 19 years. CMML was considered de novo in 71 and secondary in 14 patients. Conditioning regimens were of various intensities. Thirty-eight patients had related (34 HLA identical), and 47 (39 HLA matched) unrelated donors. The source of stem cells was marrow in 32 and peripheral blood progenitor cells in 53 patients. Acute graft-versus-host disease (aGVHD) grades II-IV occurred in 72% and chronic GVHD (cGVHD) in 26% of patients. Relapse incidence was 27% at 10 years. Relapse correlated with increasing scores by the MD Anderson prognostic score (P = .01). The major causes of death were relapse and infections ±GVHD. Progression-free survival (PFS) was 38% at 10 years. Mortality was negatively correlated with pre-HCT hematocrit (P = .007), and increased with high-risk cytogenetics (P = .02), higher HCT Comorbidity Index (P = .0008), and increased age (P = .02). WHO classification did not statistically significantly affect outcome. Thus, a proportion of patients with CMML have lasting remissions following allogeneic HCT and appear to be cured of their disease.

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KW - Comorbidity

KW - Cytogenetics

KW - Hematopoietic cell transplantation

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Allogeneic Hematopoietic Cell Transplantation for Chronic Myelomonocytic Leukemia: Relapse-Free Survival Is Determined by Karyotype and Comorbidities

Abstract

Bibliographical note

Keywords

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