BACKGROUND: Allogeneic hematopoietic cell transplantation (HCT) offers curative potential to a number of older patients with acute myeloid leukemia (AML) in their first complete remission. However, there are limited data in the literature concerning post-HCT outcomes for older patients in their second complete remission (CR2). METHODS: The purpose of the current study was to retrospectively investigate within the Center for International Blood and Marrow Transplant Research database parameters influencing posttransplant outcomes for patients 60 years of age or older undergoing HCT for AML in CR2. RESULTS: In total, 196 patients from 78 centers were identified; the median age was 64 years (range, 60-78 years). Seventy-one percent had a Karnofsky performance status ≥ 90 at the time of HCT. Reduced-intensity conditioning regimens were used in 159 patients (81%). A univariate analysis demonstrated a 3-year overall survival (OS) rate of 42% (95% confidence interval [CI], 35%-49%), a leukemia-free survival rate of 37% (95% CI, 30%-44%), a cumulative incidence of nonrelapse mortality of 25% (95% CI, 19%-32%), and a cumulative incidence of relapse (CIR) of 38% (95% CI, 31%-45%). A multivariate analysis demonstrated that cytogenetic risk was the only independent risk factor for OS (P =.023) with a hazard ratio (HR) of 1.14 (95% CI, 0.59-2.19) for intermediate-risk cytogenetics and an HR of 2.32 (95% CI, 1.05-5.14) for unfavorable-risk cytogenetics. For CIR, cytogenetic risk was also the only independent prognostic factor (P =.01) with an HR of 1.10 (95% CI, 0.47-2.56) for intermediate-risk cytogenetics and an HR of 2.98 (95% CI, 1.11-8.00) for unfavorable-risk cytogenetics. CONCLUSIONS: Allogeneic HCT is a curative treatment option for older patients with AML in CR2, particularly for those with favorable or intermediate cytogenetic risk. Cancer 2017;123:2035–2042.
Bibliographical noteFunding Information:
The Center for International Blood and Marrow Transplant Research is supported by the following: a Public Health Service grant/cooperative agreement (5U24-CA076518) from the National Cancer Institute, the National Heart, Lung, and Blood Institute, and the National Institute of Allergy and Infectious Diseases; a grant/cooperative agreement (5U10HL069294) from the National Heart, Lung, and Blood Institute and the National Cancer Institute; a contract (HHSH250201200016C) from the Health Resources and Services Administration/Department of Health and Human Services; grants (N00014-15-1-0848 and N00014-16-1-2020) from the Office of Naval Research; grants from Alexion; Amgen, Inc (corporate member); an anonymous donation to the Medical College of Wisconsin; Astellas Pharma US; AstraZeneca; the Be the Match Foundation; Bluebird Bio, Inc (corporate member); Bristol-Myers Squibb Oncology (corporate member); Celgene Corporation (corporate member); Cellular Dynamics International, Inc; Chimerix, Inc (corporate member); the Fred Hutchinson Cancer Research Center; Gamida Cell, Ltd; Genentech, Inc; Genzyme Corporation; Gilead Sciences, Inc (corporate member); Health Research, Inc; the Roswell Park Cancer Institute; HistoGenetics, Inc; Incyte Corporation; Janssen Scientific Affairs, LLC; Jazz Pharmaceuticals, Inc (corporate member); the Jeff Gordon Children's Foundation; the Leukemia & Lymphoma Society; Medac, GmbH; MedImmune; the Medical College of Wisconsin; Merck & Co, Inc (corporate member); Mesoblast; MesoScale Diagnostics, Inc; Miltenyi Biotec, Inc (corporate member); the National Marrow Donor Program; Neovii Biotech NA, Inc; Novartis Pharmaceuticals Corporation; Onyx Pharmaceuticals; Optum Healthcare Solutions, Inc; Otsuka America Pharmaceutical, Inc; Otsuka Pharmaceutical Co, Ltd (Japan); the Patient-Centered Outcomes Research Institute; PerkinElmer, Inc; Pfizer, Inc; Sanofi US (corporate member); Seattle Genetics (corporate member); Spectrum Pharmaceuticals, Inc (corporate member); the St. Baldrick's Foundation; Sunesis Pharmaceuticals, Inc (corporate member); Swedish Orphan Biovitrum, Inc; Takeda Oncology; Telomere Diagnostics, Inc; the University of Minnesota; and WellPoint, Inc (corporate member). The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, the Health Resources and Services Administration, or any other agency of the US Government.
© 2017 American Cancer Society
- Center for International Blood and Marrow Transplant Research (CIBMTR)
- acute myeloid leukemia (AML)
- allogeneic transplant
- second complete remission