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Long-term clinical outcomes of hematopoietic cell transplantation for intermediate-to-poor-risk acute myeloid leukemia during first remission according to available donor types

Standard therapy for acute myeloid leukemia (AML) consists of hematopoietic cell transplantation (HCT) including autologous-HCT (AUTO) and allogeneic-HCT from a matched-sibling donor (MSD) or well-matched unrelated donor (WM-URD). When a conventional donor is not available, HCT from a partially-matc...

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Autores principales: Yoon, Jae-Ho, Kim, Hee-Je, Park, Sung-Soo, Jeon, Young-Woo, Lee, Sung-Eun, Cho, Byung-Sik, Eom, Ki-Seong, Kim, Yoo-Jin, Lee, Seok, Min, Chang-Ki, Cho, Seok-Goo, Kim, Dong-Wook, Lee, Jong-Wook, Min, Woo-Sung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Impact Journals LLC 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522252/
https://www.ncbi.nlm.nih.gov/pubmed/28206975
http://dx.doi.org/10.18632/oncotarget.15295
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author Yoon, Jae-Ho
Kim, Hee-Je
Park, Sung-Soo
Jeon, Young-Woo
Lee, Sung-Eun
Cho, Byung-Sik
Eom, Ki-Seong
Kim, Yoo-Jin
Lee, Seok
Min, Chang-Ki
Cho, Seok-Goo
Kim, Dong-Wook
Lee, Jong-Wook
Min, Woo-Sung
author_facet Yoon, Jae-Ho
Kim, Hee-Je
Park, Sung-Soo
Jeon, Young-Woo
Lee, Sung-Eun
Cho, Byung-Sik
Eom, Ki-Seong
Kim, Yoo-Jin
Lee, Seok
Min, Chang-Ki
Cho, Seok-Goo
Kim, Dong-Wook
Lee, Jong-Wook
Min, Woo-Sung
author_sort Yoon, Jae-Ho
collection PubMed
description Standard therapy for acute myeloid leukemia (AML) consists of hematopoietic cell transplantation (HCT) including autologous-HCT (AUTO) and allogeneic-HCT from a matched-sibling donor (MSD) or well-matched unrelated donor (WM-URD). When a conventional donor is not available, HCT from a partially-matched (PM)-URD or familial-mismatched donor (FMMD) is typically considered. We analyzed 561 patients with intermediate to poor-risk molecular cytogenetics who underwent transplant from 2002 to 2013 in their first remission. Engraftment was successful in all donor types except five patients who died in aplasia. Disease-free survival (DFS) at 5 years was 61.4% for MSD, 62.1% for WM-URD, 65.3% for FMMD, 44.7% for AUTO and 36.8% for PM-URD. AUTO showed the highest relapse rate (51.0%) compared to MSD (23.5%) and FMMD (18.5%), but showed the lowest 5-year non-relapse mortality (NRM) rate (3.8%). PM-URD showed the highest NRM (29.3%) with more instances of acute graft-vs.-host disease (GVHD) with grade≥III (29.3%), compared to MSD (15.6%) and FMMD (15.7%). In a poor-risk subgroup, the 5-year DFS for FMMD and MSD was 59.8% and 46.7%, respectively, while for AUTO and PM-URD it was 12.6% and 0.0%, respectively, which was caused by a high relapse rate (87.1% in AUTO, 83.3% in PM-URD). In the intermediate-risk subgroup, the 5-year DFS of AUTO (53.9% was not different from the conventional donors in multivariate analysis, presenting a low NRM rate (5.1%). FMMD should be considered prior to PM-URD in intermediate-to-poor-risk AML and GVHD prophylaxis should be intensified when PM-URD is needed. AUTO might be considered for selected patients in the intermediate-risk group.
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spelling pubmed-55222522017-08-21 Long-term clinical outcomes of hematopoietic cell transplantation for intermediate-to-poor-risk acute myeloid leukemia during first remission according to available donor types Yoon, Jae-Ho Kim, Hee-Je Park, Sung-Soo Jeon, Young-Woo Lee, Sung-Eun Cho, Byung-Sik Eom, Ki-Seong Kim, Yoo-Jin Lee, Seok Min, Chang-Ki Cho, Seok-Goo Kim, Dong-Wook Lee, Jong-Wook Min, Woo-Sung Oncotarget Clinical Research Paper Standard therapy for acute myeloid leukemia (AML) consists of hematopoietic cell transplantation (HCT) including autologous-HCT (AUTO) and allogeneic-HCT from a matched-sibling donor (MSD) or well-matched unrelated donor (WM-URD). When a conventional donor is not available, HCT from a partially-matched (PM)-URD or familial-mismatched donor (FMMD) is typically considered. We analyzed 561 patients with intermediate to poor-risk molecular cytogenetics who underwent transplant from 2002 to 2013 in their first remission. Engraftment was successful in all donor types except five patients who died in aplasia. Disease-free survival (DFS) at 5 years was 61.4% for MSD, 62.1% for WM-URD, 65.3% for FMMD, 44.7% for AUTO and 36.8% for PM-URD. AUTO showed the highest relapse rate (51.0%) compared to MSD (23.5%) and FMMD (18.5%), but showed the lowest 5-year non-relapse mortality (NRM) rate (3.8%). PM-URD showed the highest NRM (29.3%) with more instances of acute graft-vs.-host disease (GVHD) with grade≥III (29.3%), compared to MSD (15.6%) and FMMD (15.7%). In a poor-risk subgroup, the 5-year DFS for FMMD and MSD was 59.8% and 46.7%, respectively, while for AUTO and PM-URD it was 12.6% and 0.0%, respectively, which was caused by a high relapse rate (87.1% in AUTO, 83.3% in PM-URD). In the intermediate-risk subgroup, the 5-year DFS of AUTO (53.9% was not different from the conventional donors in multivariate analysis, presenting a low NRM rate (5.1%). FMMD should be considered prior to PM-URD in intermediate-to-poor-risk AML and GVHD prophylaxis should be intensified when PM-URD is needed. AUTO might be considered for selected patients in the intermediate-risk group. Impact Journals LLC 2017-02-11 /pmc/articles/PMC5522252/ /pubmed/28206975 http://dx.doi.org/10.18632/oncotarget.15295 Text en Copyright: © 2017 Yoon et al. http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License 3.0 (http://creativecommons.org/licenses/by/3.0/) (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Clinical Research Paper
Yoon, Jae-Ho
Kim, Hee-Je
Park, Sung-Soo
Jeon, Young-Woo
Lee, Sung-Eun
Cho, Byung-Sik
Eom, Ki-Seong
Kim, Yoo-Jin
Lee, Seok
Min, Chang-Ki
Cho, Seok-Goo
Kim, Dong-Wook
Lee, Jong-Wook
Min, Woo-Sung
Long-term clinical outcomes of hematopoietic cell transplantation for intermediate-to-poor-risk acute myeloid leukemia during first remission according to available donor types
title Long-term clinical outcomes of hematopoietic cell transplantation for intermediate-to-poor-risk acute myeloid leukemia during first remission according to available donor types
title_full Long-term clinical outcomes of hematopoietic cell transplantation for intermediate-to-poor-risk acute myeloid leukemia during first remission according to available donor types
title_fullStr Long-term clinical outcomes of hematopoietic cell transplantation for intermediate-to-poor-risk acute myeloid leukemia during first remission according to available donor types
title_full_unstemmed Long-term clinical outcomes of hematopoietic cell transplantation for intermediate-to-poor-risk acute myeloid leukemia during first remission according to available donor types
title_short Long-term clinical outcomes of hematopoietic cell transplantation for intermediate-to-poor-risk acute myeloid leukemia during first remission according to available donor types
title_sort long-term clinical outcomes of hematopoietic cell transplantation for intermediate-to-poor-risk acute myeloid leukemia during first remission according to available donor types
topic Clinical Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522252/
https://www.ncbi.nlm.nih.gov/pubmed/28206975
http://dx.doi.org/10.18632/oncotarget.15295
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