Abstract
BackgroundAcute myeloid leukaemia (AML) with 17p abnormalities (abn(17p)) carries a very poor prognosis due to high refractoriness to conventional chemotherapy, and allogeneic stem cell transplantation (allo-SCT) appears as the only potential curative option.MethodsTo address outcomes after allo-SCT in patients with abn(17p), we retrospectively analysed de novo or secondary AML undergoing SCT between 2000 and 2013 from the EBMT registry.ResultsOne hundred thirty-nine patients with confirmed abn(17p) have been selected. At the time of transplant, one hundred twenty-five were in first remission (CR1). Median age was 54 years old. Abn(17p) was associated with a monosomal karyotype in 83% of patients, complex karyotype in 91%, monosomy 5 or 5q deletion (-5/5q-) in 55%, monosomy 7 (-7) in 39% and both -5/5q and -7 in 27%. Seventy-three patients (59%) had a reduced-intensity conditioning regimen. The 2-year overall survival (OS) and leukaemia-free survival (LFS) were 28 and 24%, respectively. The 2-year non-relapse mortality (NRM) was 15%, and 2-year relapse incidence (RI) was 61%. The cumulative incidence of grade II to IV acute graft-versus-host disease (GvHD) was 24% and that of chronic GvHD was 21%. In multivariate analysis, the presence of a -5/5q- in addition to abn(17p) was significantly and independently associated with worse OS, LFS and higher RI. Age and donor types did not correlate with outcome. Conditioning intensity was not statistically associated with OS, LFS and NRM when adjusted for patients’ age.ConclusionsIn contrast to the dismal prognosis reported for AML patients harbouring abn(17p) undergoing conventional chemotherapy, allogeneic SCT provides responses in about 25% of those patients transplanted in CR1.
Highlights
Acute myeloid leukaemia (AML) with 17p abnormalities (abn(17p)) carries a very poor prognosis due to high refractoriness to conventional chemotherapy, and allogeneic stem cell transplantation appears as the only potential curative option
There were 125 patients transplanted in first complete remission (CR1), while only 14 patients were transplanted in second remission (CR2)
Because of the small number of patients transplanted in Second complete remission (CR2), further analysis has been focused on First complete remission (CR1) patients
Summary
Acute myeloid leukaemia (AML) with 17p abnormalities (abn(17p)) carries a very poor prognosis due to high refractoriness to conventional chemotherapy, and allogeneic stem cell transplantation (allo-SCT) appears as the only potential curative option. Conventional post-remission high-dose chemotherapy is not capable to eradicate the initiating stem cell leukemic clone of high-risk AML, harbouring strong chemoresistance mechanisms [7], and only the potent graft-versus-leukaemia arising after allo-SCT may overcome the poor prognosis of these high-risk AML subtypes [8]. Among the heterogeneous group of high-risk AML, prognosis can be further stratified based on specific genetic abnormalities, and the potential benefit of allo-SCT differs between these diverse AML subtypes [12,13,14,15,16]. It is still questionable if distinct genetic abnormalities with a known worse outcome like complex karyotype (CK) and monosomal karyotype (MK) AML will get the same benefit from allo-SCT [17]
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