Cytogenetic Risk Determines Outcomes After Allogeneic Transplantation in Older Patients With Acute Myeloid Leukemia in Their Second Complete Remission: A Center for International Blood and Marrow Transplant Research Cohort Analysis

• Type of Material: Article
• Authors: Fotios V. Michelis, Princes Margaret Cancer Center; Vikas Gupta, Emory University; Mei-Jie Zhang, Medical College of Wisconsin; Hai-Lin Wang, Medical College of Wisconsin; Mahmoud Aljurf, Medical College of Wisconsin; Ulrike Bacher, University Medicine Goettingen; Amer Beitinjaneh, University of Miami; Yi-Bin Chen, Massachusetts General Hospital; Zachariah DeFilipp, Emory University Hospital; Robert Peter Gale, Imperial College London; Partow Kebriaei, University Texas MD Anderson Cancer Center; Mohamed Kharfan-Dabaja, H. Lee Moffitt Cancer Center & Research Institute; Hillard M. Lazarus, Seidman Cancer Center; Taiga Nishihori, H. Lee Moffitt Cancer Center & Research Institute; Richard F. Olsson, Karolinska Institutet; Betul Oran, Imperial College London; Armin Rashidi, Washington University; David A. Rizzieri, Duke University; Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Marcos de Lima, Seidman Cancer Center; H Jean Khoury, Emory University; Brenda M. Sandmaier, University of Washington; Daniel Weisdorf, University Minnesota; Wael Saber, Medical College of Wisconsin
• Language: English
• Date: 2017-06-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 American Cancer Society
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.30567
• Title of Journal or Parent Work: Cancer
• ISSN: 0008-543X
• Volume: 123
• Issue: 11
• Start Page: 2035
• End Page: 2042
• Grant/Funding Information: The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement 5U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two Grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research; and grants from Alexion; *Amgen, Inc.; Anonymous donation to the Medical College of Wisconsin; Astellas Pharma US; AstraZeneca; Be the Match Foundation; *Bluebird Bio, Inc.; *Bristol Myers Squibb Oncology; *Celgene Corporation; Cellular Dynamics International, Inc.; *Chimerix, Inc.; Fred Hutchinson Cancer Research Center; Gamida Cell Ltd.; Genentech, Inc.; Genzyme Corporation; *Gilead Sciences, Inc.; Health Research, Inc. Roswell Park Cancer Institute; HistoGenetics, Inc.; Incyte Corporation; Janssen Scientific Affairs, LLC; *Jazz Pharmaceuticals, Inc.; Jeff Gordon Children's Foundation; The Leukemia & Lymphoma Society; Medac, GmbH; MedImmune; The Medical College of Wisconsin; *Merck & Co, Inc.; Mesoblast; MesoScale Diagnostics, Inc.; *Miltenyi Biotec, Inc.; National Marrow Donor Program; Neovii Biotech NA, Inc.; Novartis Pharmaceuticals Corporation; Onyx Pharmaceuticals; Optum Healthcare Solutions, Inc.; Otsuka America Pharmaceutical, Inc.; Otsuka Pharmaceutical Co, Ltd. – Japan; PCORI; Perkin Elmer, Inc.; Pfizer, Inc; *Sanofi US; *Seattle Genetics; *Spectrum Pharmaceuticals, Inc.; St. Baldrick's Foundation; *Sunesis Pharmaceuticals, Inc.; Swedish Orphan Biovitrum, Inc.; Takeda Oncology; Telomere Diagnostics, Inc.; University of Minnesota; and *Wellpoint, Inc.
• Keywords: ADULT PATIENTS; DIAGNOSIS; Life Sciences & Biomedicine; PREDICT SURVIVAL; Science & Technology; Oncology; allogeneic transplant; AML; DONOR TRANSPLANTATION; Center for International Blood and Marrow Transplant Research (CIBMTR); elderly; STEM-CELL TRANSPLANTATION; acute myeloid leukemia (AML); second complete remission; PROGNOSTIC-FACTORS; AGE; MYELODYSPLASTIC-SYNDROME; 1ST COMPLETE REMISSION
• Research Categories: Health Sciences, Oncology; Health Sciences, General

Abstract

BACKGROUND: Allogeneic hematopoietic cell transplantation (HCT) offers curative potential to a number of older patients with acute myeloid leukemia (AML) in their first complete remission. However, there are limited data in the literature concerning post-HCT outcomes for older patients in their second complete remission (CR2). METHODS: The purpose of the current study was to retrospectively investigate within the Center for International Blood and Marrow Transplant Research database parameters influencing posttransplant outcomes for patients 60 years of age or older undergoing HCT for AML in CR2. RESULTS: In total, 196 patients from 78 centers were identified; the median age was 64 years (range, 60-78 years). Seventy-one percent had a Karnofsky performance status ≥ 90 at the time of HCT. Reduced-intensity conditioning regimens were used in 159 patients (81%). A univariate analysis demonstrated a 3-year overall survival (OS) rate of 42% (95% confidence interval [CI], 35%-49%), a leukemia-free survival rate of 37% (95% CI, 30%-44%), a cumulative incidence of nonrelapse mortality of 25% (95% CI, 19%-32%), and a cumulative incidence of relapse (CIR) of 38% (95% CI, 31%-45%). A multivariate analysis demonstrated that cytogenetic risk was the only independent risk factor for OS (P =.023) with a hazard ratio (HR) of 1.14 (95% CI, 0.59-2.19) for intermediate-risk cytogenetics and an HR of 2.32 (95% CI, 1.05-5.14) for unfavorable-risk cytogenetics. For CIR, cytogenetic risk was also the only independent prognostic factor (P =.01) with an HR of 1.10 (95% CI, 0.47-2.56) for intermediate-risk cytogenetics and an HR of 2.98 (95% CI, 1.11-8.00) for unfavorable-risk cytogenetics. CONCLUSIONS: Allogeneic HCT is a curative treatment option for older patients with AML in CR2, particularly for those with favorable or intermediate cytogenetic risk. Cancer 2017;123:2035–2042.