Rapid Donor Identification Improves Survival in High-Risk First-Remission Patients With Acute Myeloid Leukemia.

Published

Journal Article

PURPOSE: Patients with acute myeloid leukemia with high-risk cytogenetics in first complete remission (CR1) achieve better outcomes if they undergo allogeneic hematopoietic cell transplantation (HCT) compared with consolidation chemotherapy alone. However, only approximately 40% of such patients typically proceed to HCT. METHODS: We used a prospective organized approach to rapidly identify donors to improve the allogeneic HCT rate in adults with high-risk acute myeloid leukemia in CR1. Newly diagnosed patients had cytogenetics obtained at enrollment, and those with high-risk cytogenetics underwent expedited HLA typing and were encouraged to be referred for consultation with a transplantation team with the goal of conducting an allogeneic HCT in CR1. RESULTS: Of 738 eligible patients (median age, 49 years; range, 18-60 years of age), 159 (22%) had high-risk cytogenetics and 107 of these patients (67%) achieved CR1. Seventy (65%) of the high-risk patients underwent transplantation in CR1 (P < .001 compared with the historical rate of 40%). Median time to HCT from CR1 was 77 days (range, 20-356 days). In landmark analysis, overall survival (OS) among patients who underwent transplantation was significantly better compared with that of patients who did not undergo transplantation (2-year OS, 48% v 35%, respectively [P = .031]). Median relapse-free survival after transplantation in the high-risk cohort who underwent transplantation in CR1 (n = 70) was 11.5 months (range, 4-47 months), and median OS after transplantation was 14 months (range, 4-44 months). CONCLUSION: Early cytogenetic testing with an organized effort to identify a suitable allogeneic HCT donor led to a CR1 transplantation rate of 65% in the high-risk group, which, in turn, led to an improvement in OS when compared with the OS of patients who did not undergo transplantation.

Full Text

Duke Authors

Cited Authors

  • Pagel, JM; Othus, M; Garcia-Manero, G; Fang, M; Radich, JP; Rizzieri, DA; Marcucci, G; Strickland, SA; Litzow, MR; Savoie, ML; Spellman, SR; Confer, DL; Chell, JW; Brown, M; Medeiros, BC; Sekeres, MA; Lin, TL; Uy, GL; Powell, BL; Bayer, R-L; Larson, RA; Stone, RM; Claxton, D; Essell, J; Luger, SM; Mohan, SR; Moseley, A; Erba, HP; Appelbaum, FR

Published Date

  • June 2020

Published In

  • Jco Oncol Pract

Volume / Issue

  • 16 / 6

Start / End Page

  • e464 - e475

PubMed ID

  • 32048933

Pubmed Central ID

  • 32048933

Electronic International Standard Serial Number (EISSN)

  • 2688-1535

Digital Object Identifier (DOI)

  • 10.1200/JOP.19.00133

Language

  • eng

Conference Location

  • United States