Prognostic factors for outcomes of patients with refractory or relapsed acute myelogenous leukemia or myelodysplastic syndromes undergoing allogeneic progenitor cell transplantation

Raymond Wong, Munir Shahjahan, Xuemei Wang, Peter F. Thall, Marcos de Lima, Issa Khouri, James Gajewski, Jorge Alamo, Daniel Couriel, Borje S. Andersson, Michelle Donato, Chitra Hosing, Krishna Komanduri, Paolo Anderlini, Jeffrey Molldrem, Naoto T. Ueno, Elihu Estey, Cindy Ippoliti, Richard Champlin, Sergio Giralt

Research output: Contribution to journalArticle

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Abstract

Allogeneic progenitor cell transplantation is the only curative therapy for patients with refractory acute myelogenous leukemia or myelodysplastic syndromes. To identify prognostic factors in these patients, we performed a retrospective analysis of transplantation outcomes. Patients were selected if they had undergone an allogeneic transplantation between January 1988 and January 2002 and were not in remission or first untreated relapse at the time of transplantation. A total of 135 patients were identified. The median age was 49.5 years (range, 19-75 years). At the time of transplantation, 39.3% of patients had not responded to induction therapy, 37% had not responded to first salvage therapy, and 23.7% were beyond first salvage. Forty-one patients (30%) received unrelated donor progenitor cells. Eighty patients (59%) received either a reduced-intensity or a nonmyeloablative regimen. A total of 104 (77%) of 135 patients died, with a median survival time of 4.9 months (95% confidence interval, 3.9-6.6 months). The median progression-free survival was 2.9 months (95% confidence interval, 2.5-4.2 months). A Cox regression analysis showed that Karnofsky performance status, peripheral blood blasts, and tacrolimus exposure during the first 11 days after transplantation were predictive of survival. These data support the use of allogeneic transplantation for patients with relapsed or refractory acute myelogenous leukemia/myelodysplastic syndromes and suggest that optimal immune suppression early after transplantation is essential for long-term survival even in patients with refractory myeloid leukemias.

Original languageEnglish (US)
Pages (from-to)108-114
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume11
Issue number2
DOIs
StatePublished - Feb 2005
Externally publishedYes

Fingerprint

Myelodysplastic Syndromes
Cell Transplantation
Acute Myeloid Leukemia
Stem Cells
Transplantation
Homologous Transplantation
Survival
Confidence Intervals
Karnofsky Performance Status
Salvage Therapy
Unrelated Donors
Myeloid Leukemia
Tacrolimus
Disease-Free Survival
Regression Analysis
Recurrence

Keywords

  • Allogeneic progenitor cell transplantation
  • Myelodysplastic syndrome
  • Prognostic factors
  • Refractory acute myelogenous leukemia

ASJC Scopus subject areas

  • Transplantation

Cite this

Prognostic factors for outcomes of patients with refractory or relapsed acute myelogenous leukemia or myelodysplastic syndromes undergoing allogeneic progenitor cell transplantation. / Wong, Raymond; Shahjahan, Munir; Wang, Xuemei; Thall, Peter F.; de Lima, Marcos; Khouri, Issa; Gajewski, James; Alamo, Jorge; Couriel, Daniel; Andersson, Borje S.; Donato, Michelle; Hosing, Chitra; Komanduri, Krishna; Anderlini, Paolo; Molldrem, Jeffrey; Ueno, Naoto T.; Estey, Elihu; Ippoliti, Cindy; Champlin, Richard; Giralt, Sergio.

In: Biology of Blood and Marrow Transplantation, Vol. 11, No. 2, 02.2005, p. 108-114.

Research output: Contribution to journalArticle

Wong, R, Shahjahan, M, Wang, X, Thall, PF, de Lima, M, Khouri, I, Gajewski, J, Alamo, J, Couriel, D, Andersson, BS, Donato, M, Hosing, C, Komanduri, K, Anderlini, P, Molldrem, J, Ueno, NT, Estey, E, Ippoliti, C, Champlin, R & Giralt, S 2005, 'Prognostic factors for outcomes of patients with refractory or relapsed acute myelogenous leukemia or myelodysplastic syndromes undergoing allogeneic progenitor cell transplantation', Biology of Blood and Marrow Transplantation, vol. 11, no. 2, pp. 108-114. https://doi.org/10.1016/j.bbmt.2004.10.008
Wong, Raymond ; Shahjahan, Munir ; Wang, Xuemei ; Thall, Peter F. ; de Lima, Marcos ; Khouri, Issa ; Gajewski, James ; Alamo, Jorge ; Couriel, Daniel ; Andersson, Borje S. ; Donato, Michelle ; Hosing, Chitra ; Komanduri, Krishna ; Anderlini, Paolo ; Molldrem, Jeffrey ; Ueno, Naoto T. ; Estey, Elihu ; Ippoliti, Cindy ; Champlin, Richard ; Giralt, Sergio. / Prognostic factors for outcomes of patients with refractory or relapsed acute myelogenous leukemia or myelodysplastic syndromes undergoing allogeneic progenitor cell transplantation. In: Biology of Blood and Marrow Transplantation. 2005 ; Vol. 11, No. 2. pp. 108-114.
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abstract = "Allogeneic progenitor cell transplantation is the only curative therapy for patients with refractory acute myelogenous leukemia or myelodysplastic syndromes. To identify prognostic factors in these patients, we performed a retrospective analysis of transplantation outcomes. Patients were selected if they had undergone an allogeneic transplantation between January 1988 and January 2002 and were not in remission or first untreated relapse at the time of transplantation. A total of 135 patients were identified. The median age was 49.5 years (range, 19-75 years). At the time of transplantation, 39.3{\%} of patients had not responded to induction therapy, 37{\%} had not responded to first salvage therapy, and 23.7{\%} were beyond first salvage. Forty-one patients (30{\%}) received unrelated donor progenitor cells. Eighty patients (59{\%}) received either a reduced-intensity or a nonmyeloablative regimen. A total of 104 (77{\%}) of 135 patients died, with a median survival time of 4.9 months (95{\%} confidence interval, 3.9-6.6 months). The median progression-free survival was 2.9 months (95{\%} confidence interval, 2.5-4.2 months). A Cox regression analysis showed that Karnofsky performance status, peripheral blood blasts, and tacrolimus exposure during the first 11 days after transplantation were predictive of survival. These data support the use of allogeneic transplantation for patients with relapsed or refractory acute myelogenous leukemia/myelodysplastic syndromes and suggest that optimal immune suppression early after transplantation is essential for long-term survival even in patients with refractory myeloid leukemias.",
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AU - Wong, Raymond

AU - Shahjahan, Munir

AU - Wang, Xuemei

AU - Thall, Peter F.

AU - de Lima, Marcos

AU - Khouri, Issa

AU - Gajewski, James

AU - Alamo, Jorge

AU - Couriel, Daniel

AU - Andersson, Borje S.

AU - Donato, Michelle

AU - Hosing, Chitra

AU - Komanduri, Krishna

AU - Anderlini, Paolo

AU - Molldrem, Jeffrey

AU - Ueno, Naoto T.

AU - Estey, Elihu

AU - Ippoliti, Cindy

AU - Champlin, Richard

AU - Giralt, Sergio

PY - 2005/2

Y1 - 2005/2

N2 - Allogeneic progenitor cell transplantation is the only curative therapy for patients with refractory acute myelogenous leukemia or myelodysplastic syndromes. To identify prognostic factors in these patients, we performed a retrospective analysis of transplantation outcomes. Patients were selected if they had undergone an allogeneic transplantation between January 1988 and January 2002 and were not in remission or first untreated relapse at the time of transplantation. A total of 135 patients were identified. The median age was 49.5 years (range, 19-75 years). At the time of transplantation, 39.3% of patients had not responded to induction therapy, 37% had not responded to first salvage therapy, and 23.7% were beyond first salvage. Forty-one patients (30%) received unrelated donor progenitor cells. Eighty patients (59%) received either a reduced-intensity or a nonmyeloablative regimen. A total of 104 (77%) of 135 patients died, with a median survival time of 4.9 months (95% confidence interval, 3.9-6.6 months). The median progression-free survival was 2.9 months (95% confidence interval, 2.5-4.2 months). A Cox regression analysis showed that Karnofsky performance status, peripheral blood blasts, and tacrolimus exposure during the first 11 days after transplantation were predictive of survival. These data support the use of allogeneic transplantation for patients with relapsed or refractory acute myelogenous leukemia/myelodysplastic syndromes and suggest that optimal immune suppression early after transplantation is essential for long-term survival even in patients with refractory myeloid leukemias.

AB - Allogeneic progenitor cell transplantation is the only curative therapy for patients with refractory acute myelogenous leukemia or myelodysplastic syndromes. To identify prognostic factors in these patients, we performed a retrospective analysis of transplantation outcomes. Patients were selected if they had undergone an allogeneic transplantation between January 1988 and January 2002 and were not in remission or first untreated relapse at the time of transplantation. A total of 135 patients were identified. The median age was 49.5 years (range, 19-75 years). At the time of transplantation, 39.3% of patients had not responded to induction therapy, 37% had not responded to first salvage therapy, and 23.7% were beyond first salvage. Forty-one patients (30%) received unrelated donor progenitor cells. Eighty patients (59%) received either a reduced-intensity or a nonmyeloablative regimen. A total of 104 (77%) of 135 patients died, with a median survival time of 4.9 months (95% confidence interval, 3.9-6.6 months). The median progression-free survival was 2.9 months (95% confidence interval, 2.5-4.2 months). A Cox regression analysis showed that Karnofsky performance status, peripheral blood blasts, and tacrolimus exposure during the first 11 days after transplantation were predictive of survival. These data support the use of allogeneic transplantation for patients with relapsed or refractory acute myelogenous leukemia/myelodysplastic syndromes and suggest that optimal immune suppression early after transplantation is essential for long-term survival even in patients with refractory myeloid leukemias.

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KW - Myelodysplastic syndrome

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KW - Refractory acute myelogenous leukemia

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