Factors predicting long-term survival after T-cell depleted reduced intensity allogeneic stem cell transplantation for acute myeloid leukemia.
Authors
Craddock, CharlesNagra, Sandeep
Peniket, Andrew
Brookes, Cassandra
Buckley, Laura
Nikolousis, Emmanouil
Duncan, Nick
Tauro, Sudhir
Yin, John A
Liakopoulou, Effie F
Kottaridis, Panagiotis D
Snowden, John
Milligan, Donald W
Cook, Gordon
Tholouli, Eleni
Littlewood, Timothy
Peggs, Karl S
Vyas, Paresh
Clark, Fiona
Cook, Mark
Mackinnon, Stephen
Russell, Nigel
Affiliation
Centre for Clinical Haematology, Main Drive, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK. charles.craddock@uhb.nhs.ukIssue Date
2010-06
Metadata
Show full item recordAbstract
BACKGROUND: Reduced intensity conditioning regimens permit the delivery of a potentially curative graft-versus-leukemia effect in older patients with acute myeloid leukemia. Although T-cell depletion is increasingly used to reduce the risk of graft-versus-host disease its impact on the graft-versus-leukemia effect and long-term outcome post-transplant is unknown. DESIGN AND METHODS: We have characterized pre- and post-transplant factors determining overall survival in 168 patients with acute myeloid leukemia transplanted using an alemtuzumab based reduced intensity conditioning regimen with a median duration of follow-up of 37 months. RESULTS: The 3-year overall survival for patients transplanted in CR1 or CR2/CR3 was 50% (95% CI, 38% to 62%) and 44% (95% CI, 31% to 56%), respectively compared to 15% (95% CI, 2% to 36%) for patients with relapsed/refractory disease. Multivariate analysis demonstrated that both survival and disease relapse were influenced by status at transplant (P=0.008) and presentation cytogenetics (P=0.01). Increased exposure to cyclosporine A (CsA) in the first 21 days post-transplant was associated with an increased relapse risk (P<0.0001) and decreased overall survival (P<0.0001). CONCLUSIONS: Disease stage, presentation karyotype and post-transplant CsA exposure are important predictors of outcome in patients undergoing a T-cell depleted reduced intensity conditioning allograft for acute myeloid leukemia. These data confirm the presence of a potent graft-versus-leukemia effect after a T-cell depleted reduced intensity conditioning allograft in acute myeloid leukemia and identify CsA exposure as a manipulable determinant of outcome in this setting.Citation
Factors predicting long-term survival after T-cell depleted reduced intensity allogeneic stem cell transplantation for acute myeloid leukemia. 2010, 95 (6):989-95 HaematologicaJournal
HaematologicaDOI
10.3324/haematol.2009.013920PubMed ID
19951968Type
ArticleLanguage
enISSN
1592-8721ae974a485f413a2113503eed53cd6c53
10.3324/haematol.2009.013920