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Ganzel C, Yating W, Roopcharan K, Sun Z, Rowe JM, Fernandez HF, Paietta EM, Luger SM, Lazarus HM, Cripe LD, Douer D, Wiernik PH, Tallman MS, Litzow MR. Shorter long-term post-transplant life expectancy may be due to prior chemotherapy for the underlying disease: analysis of 3012 patients with acute myeloid leukemia enrolled on 9 consecutive ECOG-ACRIN trials. Bone Marrow Transplant 2024:10.1038/s41409-024-02308-0. [PMID: 38778148 DOI: 10.1038/s41409-024-02308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
Several studies reported that patients with acute myeloid leukemia (AML) who remain in long-term remission after allogeneic or autologous transplant have a shorter life expectancy, compared to the general population. However, little is known about the life expectancy of adult long-term survivors of AML who were treated with chemotherapy alone without a transplant and there have been no comparisons with survival among the general population. The current study indicates that the life expectancy of AML patients who achieved and maintained CR for at least 3 years is shorter than expected for age in the US population. This was observed also in patients who did not undergo a transplant including those who have not relapsed during the entire long follow-up period. Thus, late relapse does not explain why patients without transplants have a shortened life expectancy. Taken together, these data strongly suggest that prior chemotherapy for the underlying AML is at least a major contributing factor for the known shortened life expectancy post-transplant.
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Affiliation(s)
- C Ganzel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Wang Yating
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - K Roopcharan
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Z Sun
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - J M Rowe
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - H F Fernandez
- Moffitt Malignant Hematology & Cellular Therapy at Memorial Healthcare System, Pembroke Pines, USA
| | - E M Paietta
- Albert Einstein College of Medicine, New York, NY, USA
| | - S M Luger
- Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - H M Lazarus
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - L D Cripe
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - D Douer
- Department of Hematology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - P H Wiernik
- Cancer Research Foundation, Chappaqua, NY, USA
| | - M S Tallman
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Ganzel C, Manola J, Douer D, Rowe JM, Fernandez HF, Paietta EM, Litzow MR, Lee JW, Luger SM, Lazarus HM, Cripe LD, Wiernik PH, Tallman MS. Extramedullary Disease in Adult Acute Myeloid Leukemia Is Common but Lacks Independent Significance: Analysis of Patients in ECOG-ACRIN Cancer Research Group Trials, 1980-2008. J Clin Oncol 2017; 34:3544-3553. [PMID: 27573652 DOI: 10.1200/jco.2016.67.5892] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Extramedullary disease (EMD) at diagnosis in patients with acute myeloid leukemia (AML) has been recognized for decades. Reported herein are results from a large study of patients with AML who were treated in consecutive ECOG-ACRIN Cancer Research Group frontline clinical trials in an attempt to define the incidence and clinical implications of EMD. Methods Patients with newly diagnosed AML, age 15 years and older, who were treated in 11 clinical trials, were studied to identify EMD, as defined by physical examination, laboratory findings, and imaging results. Results Of the 3,522 patients enrolled, 282 were excluded, including patients with acute promyelocytic leukemia, incorrect diagnosis, or no adequate assessment of EMD at baseline. The overall incidence of EMD was 23.7%. The sites involved were: lymph nodes (11.5%), spleen (7.3%), liver (5.3%), skin (4.5%), gingiva (4.4%), and CNS (1.1%). Most patients (65.3%) had only one site of EMD, 20.9% had two sites, 9.5% had three sites, and 3.4% had four sites. The median overall survival was 1.035 years. In univariable analysis, the presence of any EMD ( P = .005), skin involvement ( P = .002), spleen ( P < .001), and liver ( P < .001), but not CNS ( P = .34), nodal involvement ( P = .94), and gingival hypertrophy ( P = .24), was associated with a shorter overall survival. In contrast, in multivariable analysis, adjusted for known prognostic factors such as cytogenetic risk and WBC count, neither the presence of EMD nor the number of specific sites of EMD were independently prognostic. Conclusion This large study demonstrates that EMD at any site is common but is not an independent prognostic factor. Treatment decisions for patients with EMD should be made on the basis of recognized AML prognostic factors, irrespective of the presence of EMD.
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Affiliation(s)
- Chezi Ganzel
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Judith Manola
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Dan Douer
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Jacob M Rowe
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Hugo F Fernandez
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Elisabeth M Paietta
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Mark R Litzow
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Ju-Whei Lee
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Selina M Luger
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Hillard M Lazarus
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Larry D Cripe
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Peter H Wiernik
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
| | - Martin S Tallman
- Chezi Genzel and Jacob M. Rowe, Shaare Zedek Medical Center, Jerusalem, Israel; Chezi Ganzel, Dan Douer, and Martin S. Tallman, Memorial Sloan Kettering Cancer Center; Elisabeth M. Paietta, Montefiore Medical Center; Peter H. Wiernik, St. Luke's-Roosevelt Medical Center, New York, NY; Judith Manola and Ju-Whei Lee, Dana-Farber Cancer Institute, Boston, MA; Hugo F. Fernandez, H. Lee Moffitt Cancer Institute, Tampa, FL; Mark R. Litzow, Mayo Clinic, Rochester, MN; Selina M. Luger, University of Pennsylvania, Philadelphia, PA; Hillard M. Lazarus, University Hospitals Case Medical Center, Cleveland, OH; and Larry D. Cripe, Indiana University Cancer Center, Indianapolis, IN
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