Factors predicting long-term survival after T-cell depleted reduced intensity allogeneic stem cell transplantation for acute myeloid leukemia.
dc.contributor.author | Craddock, Charles | |
dc.contributor.author | Nagra, Sandeep | |
dc.contributor.author | Peniket, Andrew | |
dc.contributor.author | Brookes, Cassandra | |
dc.contributor.author | Buckley, Laura | |
dc.contributor.author | Nikolousis, Emmanouil | |
dc.contributor.author | Duncan, Nick | |
dc.contributor.author | Tauro, Sudhir | |
dc.contributor.author | Yin, John A | |
dc.contributor.author | Liakopoulou, Effie F | |
dc.contributor.author | Kottaridis, Panagiotis D | |
dc.contributor.author | Snowden, John | |
dc.contributor.author | Milligan, Donald W | |
dc.contributor.author | Cook, Gordon | |
dc.contributor.author | Tholouli, Eleni | |
dc.contributor.author | Littlewood, Timothy | |
dc.contributor.author | Peggs, Karl S | |
dc.contributor.author | Vyas, Paresh | |
dc.contributor.author | Clark, Fiona | |
dc.contributor.author | Cook, Mark | |
dc.contributor.author | Mackinnon, Stephen | |
dc.contributor.author | Russell, Nigel | |
dc.date.accessioned | 2010-09-14T10:31:46Z | en |
dc.date.available | 2010-09-14T10:31:46Z | en |
dc.date.issued | 2010-06 | en |
dc.identifier.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 Haematologica | en |
dc.identifier.issn | 1592-8721 | en |
dc.identifier.pmid | 19951968 | en |
dc.identifier.doi | 10.3324/haematol.2009.013920 | en |
dc.identifier.uri | http://hdl.handle.net/10541/111117 | en |
dc.description.abstract | 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. | |
dc.language.iso | en | en |
dc.subject | Acute Myeloid Leukaemia | en |
dc.subject | Stem Cell Transplantation | en |
dc.title | Factors predicting long-term survival after T-cell depleted reduced intensity allogeneic stem cell transplantation for acute myeloid leukemia. | en |
dc.type | Article | en |
dc.contributor.department | Centre for Clinical Haematology, Main Drive, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK. charles.craddock@uhb.nhs.uk | en |
dc.identifier.journal | Haematologica | en |
html.description.abstract | 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. |
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