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ctt-journal > Bondarenko et al. (Abstract)

Bondarenko et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 12
doi: 10.3205/ctt-2011-No12-abstract50

© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "5th Raisa Gorbacheva Memorial Meeting Hematopoietic Stem Cell Transplantation in Children and Adults", Saint Petersburg, Russia, September 18–20, 2011

Preliminary Program

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Allogeneic hematopoietic stem cell transplantation in adolescents and adults with acute myeloid leukemia

Sergey N. Bondarenko, Alexander D. Kulagin, Elena V. Semenova, Vladimir N. Vavilov, Natalia V. Stancheva, Olga A. Slesarchuk, Maria Y. Averyanova, Olga S. Uspenskaya, Nina E. Osipova, Irina K. Golubovskaya, Marina O. Popova, Ivan S. Moiseev, Tatiana L. Gindina, Elena V. Babenko, Natalia E. Ivanova, Ludmila S. Zubarovskaya, Boris V. Afanasyev

R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, St. Petersburg, Russia

Correspondence: Sergey N. Bondarenko, R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, St. Petersburg Pavlov State Medical University, 6/8, Tolstoy str. St. Petersburg, 199044, Russia, E-mail: dr.sergeybondarenko@spam is badgmail.com

Abstract

Aim: To analyze allo-HSCT outcomes in adolescents and adults with AML and to identify the main prognostic factors.

Patients and methods: We analyzed the outcome for 104 patients with AML who received allo-HSCT from matched related (n=41) and unrelated (n=63) donors. The median age was 29 (range 15–68) years. Ninety-one (88%) patients had de novo AML, and 13 (12%) had secondary AML. Thirty-three patients (32%), 31 (30%), and 40 (38%) patients were in CR1, CR2/CR3 and non-remission stage respectively. In 71 cases cytogenetic analysis was performed: 10 (10%) patients belonged to favorable, 47 (45%) to intermediate, and 14 (13%) to the unfavorable prognosis group. Thirty-three (32%) and 71 (68%) patients received myeloablative conditioning (MAC) and non-myeloablative conditioning (NMC) respectively. The hematopoietic stem cell sources were bone marrow (BM) in 40 (38%), and peripheral blood stem cells (PBSC) in 64 (62%) patients.

Results: Patients with CR1, CR2/3 and not in remission had the following 5-year overall survival (OS): 51%, 28%, and 14% after HSCT from matched related donors (p=0.0008); 60%, 23%, and 7% after HSCT from matched unrelated donors (p=0.0093). Patients in CR1 had 67% and 53% 5-year OS after MAC and NMC (p=0.6788) respectively. There was a trend to better OS in patients receiving BM graft than in PBSC recipients (67% vs. 53%, p=0.3766). The incidence of grade 3–4 acute GVHD was borderline higher after unrelated allo-HSCT than after related allo-HSCT (35% vs. 20%, p=0.068). The cumulative incidence of extensive GVHD was 9.8% and 38.4% after related and unrelated allo-HSCT respectively (p=0.01). The main cause of death after related allo-HSCT was disease progression (67%).

Conclusions: Remission status remains the main prognostic factor in AML patients receiving allo-HSCT. Patients without remission at the time of allo-HSCT have an extremely poor prognosis. Moreover our data indicate rather poor allo-HSCT results in CR2/CR3. Conditioning regimen intensity or stem cell source have no influence on allo-HSCT outcomes. OS is similar in patients receiving related and unrelated donor allo-HSCT due to a higher relapse mortality rate in the first group and higher non-relapse mortality rate in the second one. Further studies are required for risk-adapted allo-HSCT for AML in early disease stages.

Keywords: allo-HSCT, acute myeloid leukemia