A long-term follow-up report on allogeneic stem cell transplantation for patients with primary refractory acute myelogenous leukemia: Impact of cytogenetic characteristics on transplantation outcome

被引:93
作者
Fung, HC
Stein, F
Slovak, ML
O'Donnell, MR
Snyder, DS
Cohen, S
Smith, D
Krishnan, A
Spielberger, R
Bhatia, R
Bhatia, S
Falk, P
Molina, A
Nademanee, A
Parker, P
Rodrigues, R
Rosenthal, J
Sweetman, R
Kogut, N
Sahebi, F
Popplewell, L
Vora, N
Somlo, G
Margolin, K
Chow, W
Smith, E
Forman, SJ
机构
[1] City Hope Comprehens Canc Ctr, Div Hematol BMT, Duarte, CA 91010 USA
[2] Kaiser Permanente, City Hosp BMT Program, Duarte, CA USA
关键词
acute myelogenous leukemia; allogeneic stem cell transplantation; cytogenetic characteristics; treatment failure;
D O I
10.1016/j.bbmt.2003.08.004
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The prognosis of patients with primary refractory acute myelogenous leukemia (AML) is poor. Our initial report suggested that some patients could achieve durable remission after allogeneic stem cell transplantation (SCT). Herein, we update our initial experience and report further analysis of this group of patients to determine whether there are pre-SCT prognostic factors predictive of posttransplantation relapse and survival. We reviewed the records of 68 patients who consecutively underwent transplantation at the City of Hope Cancer Center with allogeneic SCT for primary refractory AML between July 1978 and August 2000. Potential factors associated with overall survival and disease-free survival were examined. With a median follow-up of 3 years, the 3-year cumulative probabilities of disease-free survival (DFS), overall survival (OS), and relapse rate for all 68 patients were 31% (95% confidence interval [CI], 20%-42%), 30% (95% CI, 18%-41%), and 51% (95% CI, 38%-65%), respectively. In multivariate analysis, the only variables associated with shortened OS and DFS included the use of an unrelated donor as the stem cell source (relative risk, 2.23 [OS] and 2.05 [DFS]; P = .0005 and .0014, respectively) and unfavorable cytogenetics before SCT (relative risk: 1.68 [OS] and 1.58 [DFS]; P = .0107 and .0038, respectively). Allogeneic SCT can cure approximately one third of patients with primary refractory AML. Cytogenetic characteristics before SCT correlate with transplantation outcome and posttransplantation relapse. (C) 2003 American Society for Blood and Marrow Transplantation.
引用
收藏
页码:766 / 771
页数:6
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