Impact of cytogenetics on the outcome of autotransplantation for acute myeloid leukemia in first remission: Is the benefit of intensive pretransplant therapy limited to patients with good karyotypes?

J. Mehta*, R. Powles, B. Sirohi, J. Treleaven, G. J. Swansbury, S. Kulkarni, R. Saso, S. Singhal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

A total of 81 adults with acute myeloid leukemia (AML) (47% favorable karyotypes) were autografted in first remission after melphalan-total body irradiation, having received 0 (n = 7), 1 (n = 19), 2 (n = 51), or 3 (n = 4) consolidation chemotherapy cycles before harvest. The cumulative 5-year incidences of relapse and transplant-related mortality were 37 and 17%, respectively. The actuarial 5-year probability of disease-free survival (DFS) was 46%. In Cox analysis, favorable karyotypes, increasing numbers of consolidation cycles (0 vs ≥ 1 or 1 vs > 1), and higher nucleated cell doses were associated with lower relapse rates and higher DFS. Patients with favorable karyotypes benefited from every additional cycle of consolidation therapy (0 vs ≥ 1 as well as 1 vs > 1). Among patients with other karyotypes, while the benefit of one cycle of consolidation was clear (0 vs ≥ 1), there was no obvious beneficial impact of further consolidation therapy (1 vs > 1). Administration of consolidation chemotherapy prior to harvest is essential in AML. While it is possible to enhance the benefit of consolidation with favorable karyotypes by delivering two cycles, its usefulness is limited in others. In them, it may be worthwhile exploring alternatives not normally used in AML (eg high-dose cyclophosphamide) that could have antileukemic effects while permitting mobilization of stem cells.

Original languageEnglish (US)
Pages (from-to)157-164
Number of pages8
JournalBone Marrow Transplantation
Volume32
Issue number2
DOIs
StatePublished - Jul 2003

Keywords

  • Acute myeloid leukemia
  • Autotransplantation
  • Consolidation chemotherapy
  • Cytogenetics
  • Karyotype

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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