Yazarlar : Schmid C, Labopin M, Nagler A, Niederwieser D, Castagna L, Tabrizi R, Stadler M, Kuball J, Cornelissen J, Vorlicek J, Socié G, Falda M, Vindeløv L, Ljungman P, Jackson G, Kröger N, Rank A, Polge E, Rocha V, Mohty M.

Yayın : Blood.

Yayın Yılı : 2011

Pubmed Linki : http://www.ncbi.nlm.nih.gov/pubmed/22167752

Konu : Kemik İliği Nakli

Literatür İçeriği :  

Abstract

Since information on management and outcome of adults with AML relapsing after allogeneic hematopoietic stem cell transplantation with reduced intensity conditioning (RIC HSCT) is scarce, a retrospective registry study was performed by the Acute Leukemia Working Party of EBMT. Among 2815 RIC transplants performed for AML in CR between 1999 and 2008, cumulative incidence of relapse was 32±1%. Data from 263 relapsed patients were included into a detailed analysis of risk factors for overall survival (OS) and building of a prognostic score. CR was re-induced in 32%, remission duration after transplantation was the only prognostic factor for response (p=.003). Estimate 2y-OS from relapse was 14%, thereby resembling results of AML relapse after standard conditioning. Among variables available at time of relapse, remission after HSCT >5 months (HR=.50, 95%CI=.37-.67, p<.001), bone marrow blasts <27% (HR=.53, 95%CI=.40-.72, p<.001), and absence of acute GvHD after HSCT (HR=.67, 95%CI=.49-.93, p=.017) were associated with better OS. Based on these factors, three prognostic groups could be discriminated, showing OS of 32±7%, 19±4% and 4±2% at two years (p<.0001). Long-term survival was achieved almost exclusively after successful induction of CR by cytoreductive therapy, followed either by donor lymphocyte infusion, or second HSCT for consolidation.

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