Hematopoietic stem-cell transplantation for acute leukemia in relapse or primary induction failure

Michel Duval, John P. Klein, Wensheng He, Jean Yves Cahn, Mitchell Cairo, Bruce M. Camitta, Rammurti Kamble, Edward Copelan, Marcos De Lima, Vikas Gupta, Armand Keating, Hillard M. Lazarus, Mark R. Litzow, David I. Marks, Richard Maziarz, David A. Rizzieri, Gary Schiller, Kirk R. Schultz, Martin S. Tallman, Daniel Weisdorf

Research output: Contribution to journalArticle

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Abstract

Purpose: Patients with acute leukemia refractory to induction or reinduction chemotherapy have poor prognoses if they do not undergo hematopoietic stem-cell transplantation (HSCT). However, HSCT when a patient is not in complete remission (CR) is of uncertain benefit. We hypothesized that pretransplantation variables may define subgroups that have a better prognosis. Patients and Methods: Overall, 2,255 patients who underwent transplantation for acute leukemia in relapse or with primary induction failure after myeloablative conditioning regimen between 1995 and 2004 were reported to the Center for International Blood and Marrow Transplant Research. The median follow-up of survivors was 61 months. We performed multivariate analysis of pretransplantation variables and developed a predictive scoring system for survival. Results: The 3-year overall survival (OS) rates were 19% for acute myeloid leukemia (AML) and 16% for acute lymphoblastic leukemia (ALL). For AML, five adverse pretransplantation variables significantly influenced survival: first CR duration less than 6 months, circulating blasts, donor other than HLA-identical sibling, Karnofsky or Lansky score less than 90, and poor-risk cytogenetics. For ALL, survival was worse with the following: first refractory or second or greater relapse, ≥ 25% marrow blasts, cytomegalovirus- seropositive donor, and age of 10 years or older. Patients with AML who had a predictive score of 0 had 42% OS at 3 years, whereas OS was 6% for a score ≥ 3. Patients with ALL who had a score of 0 or 1 had 46% 3-year OS but only 10% OS rate for a score ≥ 3. Conclusion: Pretransplantation variables delineate subgroups with different outcomes. HSCT during relapse can achieve long-term survival in selected patients with acute leukemia.

Original languageEnglish (US)
Pages (from-to)3730-3738
Number of pages9
JournalJournal of Clinical Oncology
Volume28
Issue number23
DOIs
StatePublished - Aug 10 2010
Externally publishedYes

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Hematopoietic Stem Cell Transplantation
Leukemia
Recurrence
Survival
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia
Survival Rate
Bone Marrow
Tissue Donors
Cytomegalovirus
Cytogenetics
Survivors
Siblings
Multivariate Analysis
Transplantation
Transplants
Drug Therapy
Research

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Duval, M., Klein, J. P., He, W., Cahn, J. Y., Cairo, M., Camitta, B. M., ... Weisdorf, D. (2010). Hematopoietic stem-cell transplantation for acute leukemia in relapse or primary induction failure. Journal of Clinical Oncology, 28(23), 3730-3738. https://doi.org/10.1200/JCO.2010.28.8852

Hematopoietic stem-cell transplantation for acute leukemia in relapse or primary induction failure. / Duval, Michel; Klein, John P.; He, Wensheng; Cahn, Jean Yves; Cairo, Mitchell; Camitta, Bruce M.; Kamble, Rammurti; Copelan, Edward; De Lima, Marcos; Gupta, Vikas; Keating, Armand; Lazarus, Hillard M.; Litzow, Mark R.; Marks, David I.; Maziarz, Richard; Rizzieri, David A.; Schiller, Gary; Schultz, Kirk R.; Tallman, Martin S.; Weisdorf, Daniel.

In: Journal of Clinical Oncology, Vol. 28, No. 23, 10.08.2010, p. 3730-3738.

Research output: Contribution to journalArticle

Duval, M, Klein, JP, He, W, Cahn, JY, Cairo, M, Camitta, BM, Kamble, R, Copelan, E, De Lima, M, Gupta, V, Keating, A, Lazarus, HM, Litzow, MR, Marks, DI, Maziarz, R, Rizzieri, DA, Schiller, G, Schultz, KR, Tallman, MS & Weisdorf, D 2010, 'Hematopoietic stem-cell transplantation for acute leukemia in relapse or primary induction failure', Journal of Clinical Oncology, vol. 28, no. 23, pp. 3730-3738. https://doi.org/10.1200/JCO.2010.28.8852
Duval, Michel ; Klein, John P. ; He, Wensheng ; Cahn, Jean Yves ; Cairo, Mitchell ; Camitta, Bruce M. ; Kamble, Rammurti ; Copelan, Edward ; De Lima, Marcos ; Gupta, Vikas ; Keating, Armand ; Lazarus, Hillard M. ; Litzow, Mark R. ; Marks, David I. ; Maziarz, Richard ; Rizzieri, David A. ; Schiller, Gary ; Schultz, Kirk R. ; Tallman, Martin S. ; Weisdorf, Daniel. / Hematopoietic stem-cell transplantation for acute leukemia in relapse or primary induction failure. In: Journal of Clinical Oncology. 2010 ; Vol. 28, No. 23. pp. 3730-3738.
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abstract = "Purpose: Patients with acute leukemia refractory to induction or reinduction chemotherapy have poor prognoses if they do not undergo hematopoietic stem-cell transplantation (HSCT). However, HSCT when a patient is not in complete remission (CR) is of uncertain benefit. We hypothesized that pretransplantation variables may define subgroups that have a better prognosis. Patients and Methods: Overall, 2,255 patients who underwent transplantation for acute leukemia in relapse or with primary induction failure after myeloablative conditioning regimen between 1995 and 2004 were reported to the Center for International Blood and Marrow Transplant Research. The median follow-up of survivors was 61 months. We performed multivariate analysis of pretransplantation variables and developed a predictive scoring system for survival. Results: The 3-year overall survival (OS) rates were 19{\%} for acute myeloid leukemia (AML) and 16{\%} for acute lymphoblastic leukemia (ALL). For AML, five adverse pretransplantation variables significantly influenced survival: first CR duration less than 6 months, circulating blasts, donor other than HLA-identical sibling, Karnofsky or Lansky score less than 90, and poor-risk cytogenetics. For ALL, survival was worse with the following: first refractory or second or greater relapse, ≥ 25{\%} marrow blasts, cytomegalovirus- seropositive donor, and age of 10 years or older. Patients with AML who had a predictive score of 0 had 42{\%} OS at 3 years, whereas OS was 6{\%} for a score ≥ 3. Patients with ALL who had a score of 0 or 1 had 46{\%} 3-year OS but only 10{\%} OS rate for a score ≥ 3. Conclusion: Pretransplantation variables delineate subgroups with different outcomes. HSCT during relapse can achieve long-term survival in selected patients with acute leukemia.",
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AU - Duval, Michel

AU - Klein, John P.

AU - He, Wensheng

AU - Cahn, Jean Yves

AU - Cairo, Mitchell

AU - Camitta, Bruce M.

AU - Kamble, Rammurti

AU - Copelan, Edward

AU - De Lima, Marcos

AU - Gupta, Vikas

AU - Keating, Armand

AU - Lazarus, Hillard M.

AU - Litzow, Mark R.

AU - Marks, David I.

AU - Maziarz, Richard

AU - Rizzieri, David A.

AU - Schiller, Gary

AU - Schultz, Kirk R.

AU - Tallman, Martin S.

AU - Weisdorf, Daniel

PY - 2010/8/10

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N2 - Purpose: Patients with acute leukemia refractory to induction or reinduction chemotherapy have poor prognoses if they do not undergo hematopoietic stem-cell transplantation (HSCT). However, HSCT when a patient is not in complete remission (CR) is of uncertain benefit. We hypothesized that pretransplantation variables may define subgroups that have a better prognosis. Patients and Methods: Overall, 2,255 patients who underwent transplantation for acute leukemia in relapse or with primary induction failure after myeloablative conditioning regimen between 1995 and 2004 were reported to the Center for International Blood and Marrow Transplant Research. The median follow-up of survivors was 61 months. We performed multivariate analysis of pretransplantation variables and developed a predictive scoring system for survival. Results: The 3-year overall survival (OS) rates were 19% for acute myeloid leukemia (AML) and 16% for acute lymphoblastic leukemia (ALL). For AML, five adverse pretransplantation variables significantly influenced survival: first CR duration less than 6 months, circulating blasts, donor other than HLA-identical sibling, Karnofsky or Lansky score less than 90, and poor-risk cytogenetics. For ALL, survival was worse with the following: first refractory or second or greater relapse, ≥ 25% marrow blasts, cytomegalovirus- seropositive donor, and age of 10 years or older. Patients with AML who had a predictive score of 0 had 42% OS at 3 years, whereas OS was 6% for a score ≥ 3. Patients with ALL who had a score of 0 or 1 had 46% 3-year OS but only 10% OS rate for a score ≥ 3. Conclusion: Pretransplantation variables delineate subgroups with different outcomes. HSCT during relapse can achieve long-term survival in selected patients with acute leukemia.

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