Allogeneic stem cell transplantation as initial salvage for patients with acute myeloid leukemia refractory to high-dose cytarabine-based induction chemotherapy.

Abstract

Outcomes of patients with acute myeloid leukemia (AML) who are refractory to high-dose Cytarabine (HiDAC)-based induction are dismal. Allogeneic hematopoietic stem cell transplantation (AHSCT) as initial salvage may be effective and potentially superior to conventional salvage chemotherapy. Eighteen percent (285 of 1597) of AML patients were primary refractory to HiDAC-based regimens at the MD Anderson Cancer Center between 1995 and 2009. AHSCT was the initial salvage in 28 cases. These patients were compared against 149 patients who received salvage chemotherapy, but never received AHSCT. Patients receiving salvage chemotherapy were older, had higher bone marrow blasts percentage, and higher incidence of unfavorable cytogenetics (P < 0.001). Median time from induction to AHSCT was 76 days. Objective response was achieved in 23 of 28 patients (82%) undergoing AHSCT. The incidence of grade III/IV acute and chronic graft versus-host-disease was 11% and 29%, respectively. Median follow up for living patients is 80 months. Median overall survival (OS) was 15.7 months and 2.9 months for AHSCT and chemotherapy, respectively (P < 0.001); the 3-year OS rates were 39% and 2%, respectively. ASHCT as initial salvage therapy was identified as an independent prognostic factor for survival in multivariate analysis (HR = 3.03; P < 0.001). Initial salvage therapy with AHSCT in patients with primary HiDAC refractory AML is feasible and may yield superior outcomes to salvage chemotherapy.

• Authors: Elias Jabbour, Naval Daver, Richard Champlin, Michael Mathisen, Betul Oran, Stefan Ciurea, Issa Khouri, A Megan Cornelison, Hady Ghanem, Marylou Cardenas-Turanzas, Uday Popat, Farhad Ravandi, Sergio Giralt, Guillermo Garcia-Manero, Jorge Cortes, Hagop Kantarjian, Marcos de Lima
• Journal: American journal of hematology (Am J Hematol) Vol. 89 Issue 4 Pg. 395-8 (Apr 2014) ISSN: 1096-8652 [Electronic] United States
• PMID: 24375514 (Publication Type: Comparative Study, Evaluation Study, Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2013 Wiley Periodicals, Inc.

Chemical References

• Cytarabine

Topics

• Adult
• Aged
• Allografts
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Bone Marrow (pathology)
• Cytarabine (administration & dosage, pharmacology)
• Disease-Free Survival
• Drug Resistance, Neoplasm
• Hematopoietic Stem Cell Transplantation
• Humans
• Kaplan-Meier Estimate
• Leukemia, Myeloid, Acute (drug therapy, genetics, pathology, surgery)
• Middle Aged
• Neoplastic Stem Cells (pathology)
• Prognosis
• Proportional Hazards Models
• Remission Induction
• Retrospective Studies
• Risk Factors
• Salvage Therapy
• Transplantation Conditioning
• Treatment Outcome
• Young Adult