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Salhotra A, Yang D, Mokhtari S, Hui S, Al Malki MM, Armenian S, Sigala B, Aldoss I, Pullarkat V, Forman S, Marcucci G, Nakamura R, Artz A, Wong J, Stein A. Long-term follow-up of patients with poor-risk acute leukemia treated on a phase 2 trial undergoing intensified conditioning regimen prior to allogeneic hematopoietic cell transplantation. Leuk Lymphoma 2021; 63:1220-1226. [PMID: 34879769 DOI: 10.1080/10428194.2021.2012661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients with acute leukemia who undergo allogenic hematopoietic cell transplantation with active disease have high rates of relapse and poor overall survival (OS) post-transplant compared to patients undergoing HCT in remission. Here, we report the long-term outcomes in 32 patients who received a high-intensity conditioning regimen comprising fractionated total body irradiation (FTBI; 1200 cGy) with pharmacokinetic (PK) dosing of intravenous Busulfan (IV BU) targeted to first dose area under curve (AUC) of 700-900 µM/min and etoposide (30 mg/kg) in a prospective phase 2 clinical trial. The median age of the patients at the time of HCT was 37 years (range: 18-50) presenting with high-risk (n = 6) and relapsed/refractory(r/r) acute leukemias (n = 26). All but one patient underwent HCT using peripheral blood stem cells from matched sibling donors. At a median follow-up of 17.3 years (range 14.4-19.0), 11 patients remained alive. The disease-free survival and OS at 15 years was 34% (versus 40% at 5-years post-HCT). The 15-year cumulative incidence of relapse was 26% and non-relapse mortality (NRM) was 38% (95% CI: 21-54%) and the cumulative incidence of chronic GVHD at 15 years was 33% using a prophylactic regimen of cyclosporine A and mycophenolate mofetil. The most common life-threatening late effects were secondary malignancies, metabolic, or cardiac complications with a cumulative incidence of 6.6%, 6.6%, and 13.3%, respectively. No unusual late effects or patterns of relapse were noted on longer followed on patients treated with intensified myeloablative condition regimen. Results from this study supports continued development of intensive conditioning regimens in patients with r/r acute leukemias to improve leukemia free (LFS) and OS in this high-risk population.
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Affiliation(s)
- Amandeep Salhotra
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Dongyun Yang
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Sally Mokhtari
- Department of Clinical Translational Project Development, City of Hope National Medical Center, Duarte, CA, USA
| | - Susanta Hui
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Monzr M Al Malki
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Saro Armenian
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Brianna Sigala
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Ibrahim Aldoss
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Stephen Forman
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Guido Marcucci
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Andrew Artz
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
| | - Jeffery Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Anthony Stein
- Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA, USA
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Sabloff M, Tisseverasinghe S, Babadagli ME, Samant R. Total Body Irradiation for Hematopoietic Stem Cell Transplantation: What Can We Agree on? ACTA ACUST UNITED AC 2021; 28:903-917. [PMID: 33617507 PMCID: PMC7985756 DOI: 10.3390/curroncol28010089] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 01/23/2023]
Abstract
Total body irradiation (TBI), used as part of the conditioning regimen prior to allogeneic and autologous hematopoietic cell transplantation, is the delivery of a relatively homogeneous dose of radiation to the entire body. TBI has a dual role, being cytotoxic and immunosuppressive. This allows it to eliminate disease and create “space” in the marrow while also impairing the immune system from rejecting the foreign donor cells being transplanted. Advantages that TBI may have over chemotherapy alone are that it may achieve greater tumour cytotoxicity and better tissue penetration than chemotherapy as its delivery is independent of vascular supply and physiologic barriers such as renal and hepatic function. Therefore, the so-called “sanctuary” sites such as the central nervous system (CNS), testes, and orbits or other sites with limited blood supply are not off-limits to radiation. Nevertheless, TBI is hampered by challenging logistics of administration, coordination between hematology and radiation oncology departments, increased rates of acute treatment-related morbidity and mortality along with late toxicity to other tissues. Newer technologies and a better understanding of the biology and physics of TBI has allowed the field to develop novel delivery systems which may help to deliver radiation more safely while maintaining its efficacy. However, continued research and collaboration are needed to determine the best approaches for the use of TBI in the future.
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Affiliation(s)
- Mitchell Sabloff
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
- The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | | | - Mustafa Ege Babadagli
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada;
- Correspondence:
| | - Rajiv Samant
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada;
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Cui L, Liu Y, Pang Y, Qian T, Quan L, Cheng Z, Dai Y, Ye X, Pang Y, Shi J, Ke X, Wu D, Fu L. Emerging agents and regimens for treatment of relapsed and refractory acute myeloid leukemia. Cancer Gene Ther 2020; 27:1-14. [PMID: 31292516 DOI: 10.1038/s41417-019-0119-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/14/2019] [Accepted: 06/23/2019] [Indexed: 12/28/2022]
Abstract
Relapsed and refractory acute myeloid leukemia (R/R AML) has complicated pathogenesis. Its treatment is complicated, and the prognosis is poor. So far, there is no consensus on what is the optimal treatment strategy. With the deepening of research, new chemotherapy regimens, new small molecule inhibitors, and immunotherapy have been increasingly applied to clinical trials, providing more possibilities for the treatment of R/R AML. The most effective treatment for patients who achieve complete remission after recurrence is still sequential conditioning therapy followed by allogeneic hematopoietic cell transplantation. Finding the best combination of treatments is still an important goal for the future.
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Dou LP, Li HH, Wang L, Li F, Huang WR, Yu L, Liu DH. Efficacy and Safety of Unmanipulated Haploidentical Related Donor Allogeneic Peripheral Blood Stem Cell Transplantation in Patients with Relapsed/Refractory Acute Myeloid Leukemia. Chin Med J (Engl) 2018; 131:790-798. [PMID: 29578122 PMCID: PMC5887737 DOI: 10.4103/0366-6999.228243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Studies of haploidentical-related donor (HRD) stem cell transplantation using a combination of peripheral blood stem cells (PBSCs) and bone marrow as the graft have reported encouraging results for patients with hematological diseases. However, few studies specifically reported transplantation of only PBSCs from HRDs among patients with relapsed or refractory acute myeloid leukemia (AML). Here, the long-term outcomes and side effects of unmanipulated HRD PBSC transplantation (HRD-PBSCT) for relapsed/refractory AML were analyzed. Methods: We performed a retrospective analysis of the outcomes in relapsed/refractory AML patients who underwent PBSCT from HRDs (n = 36). Results: Thirty-one (86.1%) patients in the HRD-PBSCT group achieved platelet recovery. The cumulative incidence of acute graft-versus-host disease (aGVHD) in the HRD-PBSCT group was 40.00%, and the cumulative incidence of grades 2–4 aGVHD in this group was 13.33%. A total of 13 patients in the HRD-PBSCT group had recurrent disease at a median of 183 days after transplantation (range: 10–1700 days), reaching cumulative incidences of relapse of 50.28% at 5 years. On multivariate analysis, donor age and patient age >40 years were independent risk factors for inferior disease-free survival or overall survival (P < 0.05). The results of the present study demonstrate rapid and complete neutrophil engraftment, a low incidence of grade 2–4 aGVHD, and promising survival rates in patients after HRD-PBSCT. Thus, granulocyte colony-stimulating factor–primed PBSCs may be a reliable graft source in unmanipulated HRD-HSCT under myeloablative conditioning when no matched sibling donor is available. Conclusions: Our results support the feasibility, effectiveness, and tolerability of PBSCs as a graft source in unmanipulated HRD transplantation under myeloablative conditioning in patients with leukemia.
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Affiliation(s)
- Li-Ping Dou
- Department of Hematology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing 100853, China
| | - Hong-Hua Li
- Department of Hematology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing 100853, China
| | - Lu Wang
- Department of Hematology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing 100853, China
| | - Fei Li
- Department of Hematology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing 100853, China
| | - Wen-Rong Huang
- Department of Hematology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing 100853, China
| | - Li Yu
- Department of Hematology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing 100853, China
| | - Dai-Hong Liu
- Department of Hematology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing 100853, China
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Stahl M, Deveaux M, Montesinos P, Itzykson R, Ritchie EK, Sekeres MA, Majhail N, Barnard J, Podoltsev NA, Brunner AM, Komrokji RS, Bhatt VR, Al-kali A, Cluzeau T, Santini V, Roboz GJ, Fenaux P, Litzow M, Fathi AT, Perreault S, Kim TK, Prebet T, Vey N, Verma V, Kobbe G, Bergua J, Serrano J, Gore SD, Zeidan AM. Allogeneic Hematopoietic Stem Cell Transplantation Following the Use of Hypomethylating Agents among Patients with Relapsed or Refractory AML: Findings from an International Retrospective Study. Biol Blood Marrow Transplant 2018; 24:1754-8. [DOI: 10.1016/j.bbmt.2018.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/27/2018] [Indexed: 01/05/2023]
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Altouri S, Sabloff M, Allan D, Atkins H, Huebsch L, Maze D, Samant R, Bredeson C. Total Body Irradiation without Chemotherapy as Conditioning for an Allogeneic Hematopoietic Cell Transplantation for Adult Acute Myeloid Leukemia. Case Rep Hematol 2016; 2016:1257679. [PMID: 27957357 DOI: 10.1155/2016/1257679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/16/2016] [Indexed: 11/17/2022] Open
Abstract
Current therapies for acute myeloid leukemia (AML), failing induction, are rarely effective. We report our experience in 4 patients with AML who received 16 Gy TBI prior to allogeneic hematopoietic cell transplantation (alloHCT), between June 2010 and May 2011. Patients were 20 to 55 years of age, 2 with relapsed disease and 2 with AML failing induction. An HLA-matched graft from related or unrelated donor was infused on day 0. All but one, who received a CD34+-selected graft, received methotrexate and tacrolimus +/- antithymocyte globulin, as GVHD prophylaxis. The other patient received tacrolimus alone. Neutrophil and platelet engraftment occurred at a median of 18 and 14 days, respectively. Patients were discharged at a median of 28 days. There were no unexpected toxicities in the first 30 days. One patient had cytomegalovirus (CMV) viremia and anorexia, at two months. One patient had grade 2 acute GVHD of the skin. One patient developed chronic GVHD of the eyes, mouth, skin, joints, and lung at 4 months. Two patients died from relapse of their leukemia at days 65 and 125. Two patients remain in remission beyond day 1500. 16 Gy TBI followed by an alloHCT for AML, failing induction, is feasible and tolerable.
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Magenau J, Westervelt P, Khaled S, McGuirk J, Hari P, Eapen M, Becker PS, Parkin B, Braun T, Logan B, Wang H, Jagasia M, Rowley SD, Kim DD, Schechter T, Frey N, Scott B, Churay T, Lieland S, Forman S, Mineishi S. A multicenter trial of myeloablative clofarabine and busulfan conditioning for relapsed or primary induction failure AML not in remission at the time of allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2017; 52:59-65. [PMID: 27427921 DOI: 10.1038/bmt.2016.188] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 11/09/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) may produce long-term survival in AML after relapse or primary induction failure (PIF). However, outcomes of HCT performed for AML not in remission are historically poor given high relapse rates and transplant-related mortality. Preliminary studies suggest conditioning with clofarabine and myeloablative busulfan (CloBu4) may exert significant anti-leukemic effects without excessive toxicity in refractory hematologic malignancies. A prospective multicenter phase II trial was conducted to determine the efficacy of CloBu4 for patients proceeding directly to HCT with AML not in remission. Seventy-one patients (median age: 56 years) received CloBu4. At day 30 after HCT, 90% achieved morphologic remission. The incidence of non-relapse mortality and relapse at 2 years was 25% and 55%, respectively. The 2-year overall survival (OS) and event-free survival (EFS) were 26% and 20%, respectively. Patients entering HCT in PIF had significantly greater EFS than those in relapse (34% vs 8%; P<0.01). Multivariate analysis comparing CloBu4 with a contemporaneous cohort (Center for International Blood and Marrow Transplantation Research) of AML not in remission receiving other myeloablative conditioning (n=105) demonstrated similar OS (HR: 1.33, 95% confidence interval: 0.92-1.92; P=0.12). HCT with myeloablative CloBu4 is associated with high early response rates and may produce durable remissions in select patients with AML not in remission.
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Kawashima N, Inamoto Y, Sato T, Nakashima M, Kagaya Y, Watakabe K, Seto A, Fukushima N, Kurahashi S, Ozawa Y, Miyamura K. Long-term outcomes of allogeneic hematopoietic cell transplantation with intensified myeloablative conditioning for refractory myeloid malignancy. Bone Marrow Transplant 2016; 51:869-71. [PMID: 26878661 DOI: 10.1038/bmt.2016.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Ikegawa S, Doki N, Kurosawa S, Yamaguchi T, Sakaguchi M, Harada K, Yamamoto K, Hino Y, Shingai N, Senoo Y, Hattori K, Igarashi A, Najima Y, Kobayashi T, Kakihana K, Sakamaki H, Haraguchi K, Okuyama Y, Ohashi K. CD25 expression on residual leukemic blasts at the time of allogeneic hematopoietic stem cell transplant predicts relapse in patients with acute myeloid leukemia without complete remission. Leuk Lymphoma 2015; 57:1375-81. [PMID: 26422713 DOI: 10.3109/10428194.2015.1099644] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recent studies have shown that CD25 expression at the time of diagnosis of acute myeloid leukemia (AML) may be associated with an unfavorable outcome. We focus on patients with AML without complete remission (CR) and examine the clinical correlation between surface CD25 expression at the time of transplant and subsequent transplant outcomes. We observed a significant difference in overall survival (OS), disease-free survival (DFS) and cumulative incidence of relapse (CIR) between CD25 positive (+) (n = 22) and negative (-) groups (n = 44) (2-year OS; CD25 (+) group: 5% vs. CD25 (-) group: 40%, p < 0.0001, 2-year DFS; 5% vs. 29%, p < 0.0001, 2-year CIR; 77% vs. 52%, p = 0.03). Multivariate analysis showed that CD25 expression was an independent adverse factor for OS (p = 0.002) and relapse (p = 0.001). Patients with AML with residual CD25 positive blasts at the time of transplant may require additional therapy before or after transplant to improve survival.
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Affiliation(s)
- Shuntaro Ikegawa
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Noriko Doki
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Shuhei Kurosawa
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Tsukasa Yamaguchi
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Masahiro Sakaguchi
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Kaito Harada
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Keita Yamamoto
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Yutaro Hino
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Naoki Shingai
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Yasushi Senoo
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Keiichiro Hattori
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Aiko Igarashi
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Yuho Najima
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Takeshi Kobayashi
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Kazuhiko Kakihana
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Hisashi Sakamaki
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Kyoko Haraguchi
- b Division of Transfusion and Cell Therapy , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Yoshiki Okuyama
- b Division of Transfusion and Cell Therapy , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Kazuteru Ohashi
- a Division of Hematology , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
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Holtick U, Shimabukuro-Vornhagen A, Chakupurakal G, Theurich S, Leitzke S, Burst A, Hallek M, von Bergwelt-Baildon M, Scheid C, Chemnitz JM. FLAMSA reduced-intensity conditioning is equally effective in AML patients with primary induction failure as well as in first or second complete remission. Eur J Haematol 2015; 96:475-82. [DOI: 10.1111/ejh.12615] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Udo Holtick
- BMT Program; Department I of Internal Medicine; University of Cologne; Cologne Germany
| | | | - Geothy Chakupurakal
- BMT Program; Department I of Internal Medicine; University of Cologne; Cologne Germany
| | - Sebastian Theurich
- BMT Program; Department I of Internal Medicine; University of Cologne; Cologne Germany
| | - Silke Leitzke
- BMT Program; Department I of Internal Medicine; University of Cologne; Cologne Germany
| | - Anke Burst
- BMT Program; Department I of Internal Medicine; University of Cologne; Cologne Germany
| | - Michael Hallek
- BMT Program; Department I of Internal Medicine; University of Cologne; Cologne Germany
| | | | - Christof Scheid
- BMT Program; Department I of Internal Medicine; University of Cologne; Cologne Germany
| | - Jens M. Chemnitz
- BMT Program; Department I of Internal Medicine; University of Cologne; Cologne Germany
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Lazzarotto D, Candoni A, Nadali G, Pavan L, Lessi F, Mosna F, Simeone E, Ventura G, Gherlinzoni F, Semenzato G, Pizzolo G, Fanin R. Multicentre survey to explore current survival of patients with acute myeloid leukaemia who failed induction chemotherapy. Eur J Haematol 2015; 96:586-92. [PMID: 26186084 DOI: 10.1111/ejh.12635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute myeloid leukaemia not responsive to first induction chemotherapy (PIF-AML) still remains a challenge, and there are only few recent epidemiological data regarding the outcome of these patients. In this multicentre survey, we evaluate the prognosis and outcome of patients with PIF-AML, who were diagnosed and treated in the last 5 yrs in four Italian institutions. RESULTS One hundred PIF-AML were recorded, 57 males and 43 females, with a median age of 63 yrs (19-79), 42% were younger than 60 yrs; 42% had a secondary AML and 40% had an adverse karyotype. According to cytogenetic/molecular risk stratification at diagnosis, 33% of patients were classified as favourable/intermediate-1 risk and 56% as intermediate-2/adverse risk. After a median follow-up of 11 months (1-49), 77% of patients died, while 23% were alive (with 12/23 in cCR). Thirty-six patients underwent allogeneic SCT, and of these, 11 of 36 (31%) were alive at last follow-up. The 12- and 24-month OS probability of the whole population was 45% and 21%, respectively. In multivariate analysis, the probability of OS of the whole population was significantly improved by Allo-SCT procedure (12-month OS probability 60% vs. 35%; P < 0.0001) and was better in patients with favourable/intermediate-1 risk at diagnosis (12-month OS probability 58% vs. 40%; P = 0.028). In transplanted cases, a pretransplant responsive disease was the only significant factor to predict a favourable outcome after Allo-SCT (P = 0.006). CONCLUSION Treatment options of PIF-AML still are limited and the prognosis, even recently, remains extremely poor. This survey shows that PIF-AML is still rarely cured without Allo-SCT and confirms the importance of initiating an urgent unrelated donor search in cases without a matched sibling donor. Moreover, the outcome of Allo-SCT is better in patients who achieve a good AML debulking before transplant. To reach this goal, new predictive scores and new protocols of salvage therapy (with target drugs or combinations) need to be explored urgently in PIF-AML.
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Affiliation(s)
- Davide Lazzarotto
- Division of Hematology and SCT, University Hospital of Udine, Udine, Italy
| | - Anna Candoni
- Division of Hematology and SCT, University Hospital of Udine, Udine, Italy
| | | | - Laura Pavan
- Division of Hematology, University of Padua, Padua, Italy
| | - Federica Lessi
- Division of Hematology, University of Padua, Padua, Italy
| | - Federico Mosna
- Division of Hematology, Hospital of Treviso, Treviso, Italy
| | - Erica Simeone
- Division of Hematology and SCT, University Hospital of Udine, Udine, Italy
| | - Giovanna Ventura
- Division of Hematology and SCT, University Hospital of Udine, Udine, Italy
| | | | | | | | - Renato Fanin
- Division of Hematology and SCT, University Hospital of Udine, Udine, Italy
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Abstract
Allogeneic stem cell transplantation (SCT) is an increasingly important therapeutic option for the treatment of adult patients with acute myeloid leukemia. Here we review the current indications of SCT in this disease. While patients with favorable cytogenetics should receive consolidation chemotherapy, patients with unfavorable karyotype are prime candidates for SCT or new approaches to SCT (which should be done in first complete remission). Patients with intermediate prognoses should also receive SCT in first complete remission. In the absence of a suitable matched related donor, most patients will be able to find an alternative donor to proceed to a potentially curative allogeneic transplantation. The use of reduced-intensity conditioning regimens before SCT has allowed patients in the sixth or seventh decades of life to be routinely transplanted. Despite major differences among transplant centers in the intensity and composition of the conditioning regimen and immunosuppression, choice of graft source, postgraft immune-modulation, and supportive care, there has been a dramatic improvement in terms of tolerance. Although it is presumed to be a curative strategy, major complications of SCT remain graft-versus-host disease, delayed immune recovery, multiple comorbidities, and relapse after transplant.
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Kanate AS, Pasquini MC, Hari PN, Hamadani M. Allogeneic hematopoietic cell transplant for acute myeloid leukemia: Current state in 2013 and future directions. World J Stem Cells 2014; 6:69-81. [PMID: 24772235 PMCID: PMC3999783 DOI: 10.4252/wjsc.v6.i2.69] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/03/2014] [Accepted: 03/17/2014] [Indexed: 02/06/2023] Open
Abstract
Acute myeloid leukemia (AML) represents a heterogeneous group of high-grade myeloid neoplasms of the elderly with variable outcomes. Though remission-induction is an important first step in the management of AML, additional treatment strategies are essential to ensure long-term disease-free survival. Recent pivotal advances in understanding the genetics and molecular biology of AML have allowed for a risk-adapted approach in its management based on relapse-risk. Allogeneic hematopoietic cell transplantation (allo-HCT) represents an effective therapeutic strategy in AML providing the possibility of cure with potent graft-versus-leukemia reactions, with a demonstrable survival advantage in younger patients with intermediate- or poor-risk cytogenetics. Herein we review the published data regarding the role of allo-HCT in adults with AML. We searched MEDLINE/PubMed and EMBASE/Ovid. In addition, we searched reference lists of relevant articles, conference proceedings and ongoing trial databases. We discuss the role of allo-HCT in AML patients stratified by cytogenetic- and molecular-risk in first complete remission, as well as allo-HCT as an option in relapsed/refractory AML. Besides the conventional sibling and unrelated donor allografts, we review the available data and recent advances for alternative donor sources such as haploidentical grafts and umbilical cord blood. We also discuss conditioning regimens, including reduced intensity conditioning which has broadened the applicability of allo-HCT. Finally we explore recent advances and future possibilities and directions of allo-HCT in AML. Practical therapeutic recommendations have been made where possible based on available data and expert opinion.
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Hasle H. A critical review of which children with acute myeloid leukaemia need stem cell procedures. Br J Haematol 2014; 166:23-33. [PMID: 24749666 DOI: 10.1111/bjh.12900] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 03/03/2014] [Indexed: 12/21/2022]
Abstract
The last decades have seen parallel improvements in chemotherapy-based and haematopoietic stem cell transplantation (HSCT) regimens for acute myeloid leukaemia (AML) in children. There has been no consensus on indication for HSCT. Reserving HSCT for high-risk and relapsed patients spare many patients from the long-term toxicity of this treatment. The results of matched unrelated donor HSCT equal family donor transplantation and the presence of a matched sibling should no longer be a transplant indication. Minimal residual disease measured by flow cytometry may identify poor responders benefitting from HSCT in first complete remission (CR1) and those with a favourable response to induction therapy who do not need HSCT even with adverse cytogenetic aberrations. FLT3-internal tandem duplication without NPM1 mutation has a very high relapse rate despite favourable response and HSCT is indicated in CR1 in these cases. Finding the optimal indications for HSCT is a delicate balance between risk of relapse and late effects.
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Affiliation(s)
- Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
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15
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Lee SJ, Storer B, Wang H, Lazarus HM, Waller EK, Isola LM, Klumpp TR, Umejiego JBC, Savani BN, Loren AW, Cairo MS, Camitta BM, Cutler CS, George B, Jean Khoury H, Marks DI, Rizzieri DA, Copelan EA, Gupta V, Liesveld JL, Litzow MR, Miller AM, Schouten HC, Gale RP, Cahn JY, Weisdorf DJ. Providing personalized prognostic information for adult leukemia survivors. Biol Blood Marrow Transplant 2013; 19:1600-7. [PMID: 24018394 DOI: 10.1016/j.bbmt.2013.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/25/2013] [Indexed: 11/30/2022]
Abstract
Prediction of subsequent leukemia-free survival (LFS) and chronic graft-versus-host disease (GVHD) in adults with acute leukemia who survived at least 1 year after allogeneic hematopoietic cell transplantation is difficult. We analyzed 3339 patients with acute myeloid leukemia and 1434 patients with acute lymphoblastic leukemia who received myeloablative conditioning and related or unrelated stem cells from 1990 to 2005. Most clinical factors predictive of LFS in 1-year survivors were no longer significant after 2 or more years. For acute myeloid leukemia, only disease status (beyond first complete remission) remained a significant adverse risk factor for LFS 2 or more years after transplantation. For lymphoblastic leukemia, only extensive chronic GVHD remained a significant adverse predictor of LFS in the second and subsequent years. For patients surviving for 1 year without disease relapse or extensive chronic GVHD, the risk of developing extensive chronic GVHD in the next year was 4% if no risk factors were present and higher if noncyclosporine-based GVHD prophylaxis, an HLA-mismatched donor, or peripheral blood stem cells were used. Estimates for subsequent LFS and extensive chronic GVHD can be derived for individual patients or populations using an online calculator (http://www.cibmtr.org/LeukemiaCalculators). This prognostic information is more relevant for survivors than estimates provided before transplantation.
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Affiliation(s)
- Stephanie J Lee
- Fred Hutchinson Cancer Research Center, Seattle, Washington.
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16
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Leunis A, Redekop WK, van Montfort KAGM, Löwenberg B, Uyl-de Groot CA. The development and validation of a decision-analytic model representing the full disease course of acute myeloid leukemia. Pharmacoeconomics 2013; 31:605-621. [PMID: 23640102 DOI: 10.1007/s40273-013-0058-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The treatment of acute myeloid leukemia (AML) is moving towards personalized medicine. However, due to the low incidence of AML, it is not always feasible to evaluate the cost-effectiveness of personalized medicine using clinical trials. Decision analytic models provide an alternative data source. OBJECTIVE The aim of this study was to develop and validate a decision analytic model that represents the full disease course of AML. METHODS We used a micro simulation with discrete event components to incorporate both patient and disease heterogeneity. Input parameters were calculated from patient-level data. Two hematologists critically evaluated the model to ensure face validity. Internal and external validity was tested by comparing complete remission (CR) rates and survival outcomes of the model with original data, other clinical trials and a population-based study. RESULTS No significant differences in patient and treatment characteristics, CR rate, 5-year overall and disease-free survival were found between the simulated and original data. External validation showed no significant differences in survival between simulated data and other clinical trials. However, differences existed between the simulated data and a population-based study. CONCLUSIONS The model developed in this study is proved to be valid for analysis of an AML population participating in a clinical trial. The generalizability of the model to a broader patient population has not been proven yet. Further research is needed to identify differences between the clinical trial population and other AML patients and to incorporate these differences in the model.
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Affiliation(s)
- Annemieke Leunis
- Institute for Medical Technology Assessment/Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
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18
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Lee SE, Yoon JH, Shin SH, Yahng SA, Cho BS, Eom KS, Kim YJ, Min CK, Lee S, Cho SG, Kim DW, Lee JW, Min WS, Park CW, Kim M, Lim J, Kim Y, Han K, Kim HJ. Impact of pre-transplant marrow blasts on survival of allogeneic stem cell transplantation in adult acute myeloid leukemia. Int J Hematol 2013; 97:640-9. [DOI: 10.1007/s12185-013-1312-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 03/12/2013] [Accepted: 03/12/2013] [Indexed: 11/28/2022]
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Wareham NE, Heilmann C, Abrahamsson J, Forestier E, Gustafsson B, Ha SY, Heldrup J, Jahnukainen K, Jónsson ÓG, Lausen B, Palle J, Zeller B, Hasle H. Outcome of poor response paediatric AML using early SCT. Eur J Haematol 2013; 90:187-94. [DOI: 10.1111/ejh.12051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2012] [Indexed: 01/24/2023]
Affiliation(s)
- Neval E. Wareham
- Department of Paediatrics; The University Hospital Rigshospitalet; Copenhagen; Denmark
| | - Carsten Heilmann
- Department of Paediatrics; The University Hospital Rigshospitalet; Copenhagen; Denmark
| | - Jonas Abrahamsson
- Department of Paediatrics; The Queen Silvia Children's Hospital; Sahlgrenska University Hospital; Gothenburg; Sweden
| | | | - Britt Gustafsson
- Department of Clinical Science; Intervention and Technology; Karolinska Institutet, Karolinska University Hospital; Huddinge; Sweden
| | - Shau-Yin Ha
- Department of Paediatrics; Queen Mary Hospital and Hong Kong Paediatric Haematology & Oncology Study Group (HKPHOSG); Hong Kong; China
| | - Jesper Heldrup
- Department of Paediatrics; University Hospital Lund; Lund; Sweden
| | - Kirsi Jahnukainen
- Division of Haematology-Oncology and Stem Cell Transplantation; Children's Hospital; University of Helsinki; Helsinki University Central Hospital; Helsinki; Finland
| | - Ólafur G. Jónsson
- Children's Hospital Iceland; Landspítali - University Hospital; Reykjavík; Iceland
| | - Birgitte Lausen
- Department of Paediatrics; The University Hospital Rigshospitalet; Copenhagen; Denmark
| | - Josefine Palle
- Department of Women's and Children's Health; University Children's Hospital; Uppsala; Sweden
| | - Bernward Zeller
- Department of Paediatrics; Oslo University Hospital Rikshospitalet; Oslo; Norway
| | - Henrik Hasle
- Department of Paediatrics; Aarhus University Hospital Skejby; Aarhus; Denmark
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20
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Bertz H, Spyridonidis A, Ihorst G, Engelhardt M, Grüllich C, Wäsch R, Marks R, Finke J. Marrow versus Blood-Derived Stem Cell Grafts for Allogeneic Transplantation from Unrelated Donors in Patients with Active Myeloid Leukemia or Myelodysplasia. Biol Blood Marrow Transplant 2012; 18:894-902. [DOI: 10.1016/j.bbmt.2011.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 11/14/2011] [Indexed: 11/28/2022]
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21
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Magenau J, Tobai H, Pawarode A, Braun T, Peres E, Reddy P, Kitko C, Choi S, Yanik G, Frame D, Harris A, Erba H, Kujawski L, Elenitoba-Johnson K, Sanks J, Jones D, Paczesny S, Ferrara J, Levine J, Mineishi S. Clofarabine and busulfan conditioning facilitates engraftment and provides significant antitumor activity in nonremission hematologic malignancies. Blood 2011; 118:4258-64. [PMID: 21841163 DOI: 10.1182/blood-2011-06-358010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Patients with hematologic malignancies not in remission before allogeneic hematopoietic stem cell transplantation (HSCT) have a poor prognosis. To improve the antitumor activity of conditioning, we combined clofarabine with myeloablative doses of busulfan in a phase 1/2 study in nonremission hematologic malignancies. Forty-six patients were enrolled, including 31 patients with nonremission acute myelogenous leukemia (AML). Patients had a median age of 53 years, with a median comorbidity index of 3. Donors were unrelated, HLA mismatched, or both in 59% of patients. Common grade III to IV nonhematologic toxicities included transient transaminitis (50%), mucositis (24%), hand-foot syndrome (13%), transient hypoxia (13%), nausea/vomiting (9%), and diarrhea (9%). All patients engrafted. Complete remission was achieved in 80% of all patients by day +30 and in 100% of AML patients without prior hematopoietic stem cell transplantation. Two-year nonrelapse mortality for all patients was 31%, and overall survival was 28%. In AML, the overall survival was 48% at 1 year and 35% at 2 years. These data suggest that clofarabine combined with myeloablative doses of busulfan is well tolerated, secures engraftment, and possesses significant antitumor activity, particularly in nonremission AML. This study is registered at www.ClinicalTrials.gov under identifier NCT00556452.
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22
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Mehta DR, Foon KA, Redner RL, Raptis A, Agha M, Hou JZ, Duggal S, Luong TM, Schlesselman JJ, Boyiadzis M. Fludarabine and cytarabine in patients with acute myeloid leukemia refractory to two different courses of front-line chemotherapy. Leuk Res 2011; 35:885-8. [DOI: 10.1016/j.leukres.2010.12.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/29/2010] [Accepted: 12/30/2010] [Indexed: 01/19/2023]
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23
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Porter DL. ASH 2009 meeting report-Top 10 clinically-oriented abstracts in hematopoietic stem cell transplantation. Am J Hematol 2010. [DOI: 10.1002/ajh.21628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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McHayleh W, Sehgal R, Redner RL, Raptis A, Agha M, Natale J, Luong TM, Schlesselman JJ, Foon KA, Boyiadzis M. Mitoxantrone and etoposide in patients with newly diagnosed acute myeloid leukemia with persistent leukemia after a course of therapy with cytarabine and idarubicin. Leuk Lymphoma 2009; 50:1848-53. [DOI: 10.3109/10428190903216788] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Kümpers P, Koenecke C, Hecker H, Hellpap J, Horn R, Verhagen W, Buchholz S, Hertenstein B, Krauter J, Eder M, David S, Göhring G, Haller H, Ganser A. Angiopoietin-2 predicts disease-free survival after allogeneic stem cell transplantation in patients with high-risk myeloid malignancies. Blood 2008; 112:2139-48. [DOI: 10.1182/blood-2007-12-130021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Emerging data suggest a critical role for bone marrow angiogenesis in hematologic malignancies. The angiopoietin/Tie ligand-receptor system is an essential regulator of this process. We evaluated whether circulating angiopoietin-2 (Ang-2) is a predictor for the probability of disease-free survival (DFS) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) for high-risk acute myeloid leukemia or myelodysplastic syndrome. Ang-2 was measured by enzyme-linked immunosorbent assay in serum from 20 healthy controls and 90 patients with acute myeloid leukemia or myelodysplastic syndrome before conditioning for HSCT. Circulating Ang-2 was elevated in patients (median, 2.21 ng/mL; range, 0.18-48.84 ng/mL) compared with controls (median, 0.87 ng/mL; range, 0.27-4.51 ng/mL; P < .001). Multivariate analyses confirmed the independent prognostic impact of Ang-2 (hazard ratio [HR] = 2.46; 95% confidence interval [CI], 1.27-4.76, P = .005), percentage of bone marrow infiltration (HR = 1.14; 95% CI, 1.01-1.29, P = .033), and chemotherapy cycles before HSCT (HR = 1.38; 95% CI, 1.01-1.08, P = .048). Regression tree analysis detected optimal cutoff values for Ang-2 and recursively identified bone marrow blasts and Ang-2 as the best predictors for DFS. Because few predictors for DFS exist in the setting of allo-HSCT, Ang-2 may be used as a readily available powerful biomarker to pre-estimate DFS and may open new perspectives for risk-adapted treatment of high-risk myeloid malignancies.
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26
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Kitko CL, Paczesny S, Yanik G, Braun T, Jones D, Whitfield J, Choi SW, Hutchinson RJ, Ferrara JLM, Levine JE. Plasma elevations of tumor necrosis factor-receptor-1 at day 7 postallogeneic transplant correlate with graft-versus-host disease severity and overall survival in pediatric patients. Biol Blood Marrow Transplant 2008; 14:759-65. [PMID: 18541194 DOI: 10.1016/j.bbmt.2008.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 04/09/2008] [Indexed: 10/22/2022]
Abstract
Tumor necrosis factor-alpha (TNF-alpha) is known to play a role in the pathogenesis of graft-versus-host disease (GVHD), a cause of significant morbidity and treatment-related mortality (TRM) after allogeneic hematopoietic stem cell transplantation (HCT). We measured the concentration of TNF-Receptor-1 (TNFR1) in the plasma of HCT recipients as a surrogate marker for TNF-alpha both prior to transplant and at day 7 in 82 children who underwent a myeloablative allogeneic HCT at the University of Michigan between 2000 and 2005. GVHD grade II-IV developed in 39% of patients at a median of 20 days after HCT. Increases in TNFR1 level at day 7 post-HCT, expressed as ratios compared to pretransplant baseline, correlated with the severity of GVHD (P = .02). In addition, day 7 TNFR1 ratios >2.5 baseline were associated with inferior 1-year overall survival (OS 51% versus 74%, P = .04). As an individual biomarker, TNFR1 lacks sufficient precision to be used as a predictor for the development of GVHD. However, increases in the concentration of TNFR1, which are detectable up to 2 weeks in advance of clinical manifestations of GVHD, correlate with survival in pediatric HCT patients.
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Affiliation(s)
- Carrie L Kitko
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA.
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27
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Hamadani M, Awan FT, Copelan EA. Hematopoietic stem cell transplantation in adults with acute myeloid leukemia. Biol Blood Marrow Transplant 2008; 14:556-67. [PMID: 18410898 DOI: 10.1016/j.bbmt.2008.02.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 02/27/2008] [Indexed: 11/26/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is an integral part of the treatment of many patients with acute myeloid leukemia (AML). Despite extensive study, the appropriate role and timing of allogeneic and autologous transplantation in AML are poorly defined. This review critically analyzes the extensive literature, focusing on the recent advances, and provides practical recommendations for the use of HSCT in AML.
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Affiliation(s)
- Mehdi Hamadani
- Division of Hematology & Oncology, Arthur G. James Cancer Hospital, Ohio State University, Columbus, Ohio, USA
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28
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Bonnanomi S, Connor P, Webb D, Ancliff P, Amrolia P, Rao K, Mccloskey D, Hemmatpour S, Goulden N, Veys P. Successful outcome of allo-SCT in high-risk pediatric AML using chemotherapy-only conditioning and post transplant immunotherapy. Bone Marrow Transplant 2008; 42:253-7. [DOI: 10.1038/bmt.2008.160] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
This chapter addresses the impact of the disease and disease status on the outcome of stem-cell transplantation. In consideration of the other topics addressed within this volume we have elected to focus on allogeneic rather than autologous transplantation. Furthermore we have not tried to be comprehensive and discuss the role of disease status in all conditions amenable to allografting, but rather to review the evidence that exists for selected haematological malignancies. Where possible we have made some clear recommendations, but where evidence is less clear we have indicated the ongoing controversies.
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MESH Headings
- Acute Disease
- Adult
- Benzamides
- Female
- Hematopoietic Stem Cell Transplantation/mortality
- Humans
- Imatinib Mesylate
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid/therapy
- Male
- Multiple Myeloma/therapy
- Myelodysplastic Syndromes/therapy
- Neoplasm Staging
- Neoplasms/therapy
- Piperazines/therapeutic use
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Prognosis
- Pyrimidines/therapeutic use
- Recurrence
- Risk Assessment
- Survival Analysis
- Transplantation, Homologous
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Affiliation(s)
- Aristeidis Chaidos
- Department of Haematology, Hammersmith Hospital, DuCane Road, London W12 0NN, UK
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30
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Kiss TL, Sabry W, Lazarus HM, Lipton JH. Blood and marrow transplantation in elderly acute myeloid leukaemia patients - older certainly is not better. Bone Marrow Transplant 2007; 40:405-16. [PMID: 17572706 DOI: 10.1038/sj.bmt.1705747] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Acute myeloid leukaemia in the elderly is a disease with distinct biological properties, commonly associated with leukaemic cell treatment resistance and with an increased number of high-risk features, including concomitant myelodysplasia and poor-risk cytogenetic abnormalities such as monosomy 5 and 7. Complete remission rates after standard induction chemotherapy in patients above age 60 years are less than 50%, with long-term survival rates below 10%. Post-remission stem cell transplant therapies have not been studied extensively. Autologous transplants can result in an acceptable 3-year leukaemia-free survival rate of up to 47%, yet this procedure is applicable only to a small minority of patients. Myeloablative allogeneic transplants similarly show feasibility in selected few patients and in general are very toxic. Non-myeloablative allogeneic transplants are associated with reduced toxicity, but are plagued by an increased relapse rate. The latter strategy appears promising, but must be validated in larger, multi-centre prospective trials, in which outcomes are compared to non-transplant approaches.
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Affiliation(s)
- T L Kiss
- Department of Hematology, Maisonneuve Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada.
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31
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Kikushige Y, Takase K, Miyamoto T, Numata A, Kamesaki K, Fukuda T, Nagafuji K, Gondo H, Harada M. Late relapse of acute myelogenous leukemia followed by epstein-barr virus-associated lymphoproliferative disease 11 years after allogeneic bone marrow transplantation. Int J Hematol 2007; 84:441-4. [PMID: 17189227 DOI: 10.1532/ijh97.06113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) following myeloablative conditioning represents the treatment of choice for patients with chemotherapy-resistant leukemia. We describe a 49-year-old man with advanced, refractory acute myelogenous leukemia (AML) that was treated successfully by allogeneic bone marrow transplantation from a sibling donor with HLA mismatched at 1 locus. However, the patient developed a quiescent form of chronic graft-versus-host disease (GVHD) 7 years after transplantation, requiring long-term immunosuppressive therapy. AML relapse was documented 11 years after transplantation. Subsequently, Epstein-Barr virus (EBV)-associated posttransplantation lymphoproliferative disorder (PTLD) was also diagnosed. Immune reconstitution after allo-HSCT might have been impaired by the persistent chronic GVHD and the prolonged administration of immunosuppressive agents. As a result, immune surveillance against remaining quiescent leukemic cells as well as viral infection may have been defective, leading to the relapse of leukemia and EBV-associated PTLD.
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Affiliation(s)
- Yoshikane Kikushige
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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32
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Fielding AK, Richards SM, Chopra R, Lazarus HM, Litzow MR, Buck G, Durrant IJ, Luger SM, Marks DI, Franklin IM, McMillan AK, Tallman MS, Rowe JM, Goldstone AH. Outcome of 609 adults after relapse of acute lymphoblastic leukemia (ALL); an MRC UKALL12/ECOG 2993 study. Blood 2006; 109:944-50. [PMID: 17032921 DOI: 10.1182/blood-2006-05-018192] [Citation(s) in RCA: 599] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Most adults with acute lymphoblastic leukemia (ALL) who achieve complete remission (CR) will relapse. We examined the outcome of 609 adults with recurring ALL, all of whom were previously treated on the Medical Research Council (MRC) UKALL12/ECOG2993 study, where the overall survival (OS) of newly diagnosed patients is 38% (95% confidence interval [CI]=36%-41%) at 5 years. By contrast, OS at 5 years after relapse was 7% (95% CI=4%-9%). Factors predicting a good outcome after salvage therapy were young age (OS of 12% in patients younger than 20 years vs OS of 3% in patients older than 50 years; 2P<.001) and short duration of first remission (CR1) (OS of 11% in those with a CR1 of more than 2 years versus OS of 5% in those with a CR1 of less than 2 years; 2P<.001). Treatment received in CR1 did not influence outcome after relapse. In a very highly selected subgroup of patients who were able to receive HSCT after relapse, some were long-term survivors. We conclude from a large, unselected series with mature follow-up that most adults with recurring ALL, whatever their prior treatment, cannot be rescued using currently available therapies. Prevention of recurrence is the best strategy for long-term survival in this disease.
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Affiliation(s)
- Adele K Fielding
- Royal Free and University College London Medical School, and Christie Hospital National Health Service Trust, Manchester, UK.
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Kuendgen A, Gräf T, Zohren F, Hildebrandt B, Hünerlitürkoglu A, Gattermann N, Haas R, Kobbe G. Induction of complete remission in a patient with acute myeloid leukemia refractory to high-dose chemotherapy through treatment with 5-azacytidine. Leuk Res 2006; 31:407-9. [PMID: 16890286 DOI: 10.1016/j.leukres.2006.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Revised: 06/09/2006] [Accepted: 06/10/2006] [Indexed: 11/21/2022]
Abstract
For patients with acute myeloid leukemia refractory to intensive chemotherapy prognosis is very poor and treatment options are limited. 5-Azacytidine, a demethylating drug, is effective in the treatment of myelodysplastic syndromes when administered at a low-dose, subcutaneously. We report a case of a patient with AML refractory to induction chemotherapy as well as to two high-dose salvage regimens. The patient achieved CR through monotherapy with low-dose azacytidine.
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Affiliation(s)
- A Kuendgen
- Department of Hematology, Oncology, Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, D-40225 Düsseldorf, Germany.
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34
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Current Awareness in Hematological Oncology. Hematol Oncol 2005; 23:136-43. [DOI: 10.1002/hon.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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