The outcomes of allogeneic stem cell transplantation in AML patients with monosomal karyotypes.

Abstract

6538 Background: The prognosis of acute myeloid leukemia (AML) with monosomal karyotype (MK) was reported extremely poor. We investigated the role of allogeneic stem cell transplantation (allo-SCT) for those with MK. Methods: A total of 114 patients who received allo-SCT for treatment of AML were retrospectively analyzed. All patients were treated with standard induction chemotherapy with anthracycline and cytarabine. Cytogenetic abnormalties were grouped according to recently published MRC criteria and MK was defined as at least two autosomal monosomies or one monosomy plus one or more structural abnormality. Results: Thirteen patients had favorable cytogenetic risk, 78 intermediate, 11 adverse without MK, and 12 adverse with MK at the time of diagnosis. Among 12 patients with MK, 5 (41.7%) achieved CR after induction therapy, 1 (8.3%) relapsed and 6 (50.0%) refractory at the time of allo-SCT. The 2-year overall survival (OS) was significantly lower for patients with MK (17.5%) compared to favorable (76.9%), intermediate (61.0%), and adverse without MK (36.4%, p=0.017). In the multivariate analysis, those with MK was related with extremely poor outcomes (HR 6.02, p=0.008), which was independent risk factor for OS. Survival benefit was observed in MK group with chronic GVHD compared to those without chronic GVHD. The median survival was 272 days with chronic GVHD (95% CI 204-339 days) compared to 159 days (95% CI 76-172 days) without chronic GVHD (p=0.010). Conclusions: The prognosis remained poor in patients with MK despite of allo-SCT. Innovative approaches to induce GLV effects are needed to improve SCT outcomes in patients with MK.