Conditioning intensity in secondary AML with prior myelodysplastic syndrome/myeloproliferative disorders: An EBMT ALWP study

Salyka Sengsayadeth, Katie S. Gatwood*, Ariane Boumendil, Myriam Labopin, Jürgen Finke, Arnold Ganser, Matthias Stelljes, Gerhard Ehninger, Dietrich Beelen, Dietger Niederwieser, Didier Blaise, Peter Dreger, Ghulam Mufti, Patrice Chevallier, Audrey Mailhol, Maria H. Gilleece, Norbert Gorin, Jordi Esteve, Fabio Ciceri, Frederic BaronChristoph Schmid, Sebastian Giebel, Mohamad Mohty, Bipin N. Savani, Arnon Nagler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

31 Citations (Scopus)

Abstract

Patients with secondary AML (sAML) with antecedent myelodysplastic syndrome (MDS) or myeloproliferative neoplasms (MPNs) tend to have high-risk disease based on the older age of patients, high-risk cytogenetics, and higher number of prior treatments. Allogeneic hematopoietic cell transplant (HCT) is the only potentially curative therapy available. Eight hundred and two adults with sAML and prior MDS/MPN who received a first HCT between 2000 and 2016 were included in the European Society for Blood and Marrow Transplant (EBMT) Acute Leukemia Working Party (ALWP) study. Median age of the cohort was 59.6 years (range, 18.6-78.6 years). Myeloablative conditioning (MAC) was given to 40% of patients, and 60% received reduced-intensity conditioning (RIC). Overall, the 2-year cumulative incidence of relapse (RI) was 37%, leukemia-free survival (LFS) was 40%, overall survival (OS) was 46%, nonrelapsemortality (NRM) was 23%, and chronic graft-versus-host disease (cGVHD) was 39%. In univariate analysis, a statistical difference between conditioning regimens 6 months after HCT in favor of theMAC group was noted with regard to RI (hazard ratio [HR], 1.47; P 5 .03), LFS (HR, 1.43; P 5 .01), and OS (HR, 1.55; P, .05). There was no difference in the cumulative incidence of NRM (HR, 1.38; P 5 .15). This effect was similarly seen in multivariate analysis (MVA): cumulative incidence of relapse (HR, 1.79; P, .05), LFS (HR, 1.43; P 5 .02), and OS (HR, 1.53; P 5 .005) with no difference in NRM (HR, 1; P 5 .98). This EBMT ALWP analysis suggests that long-term survival can be achieved in patients with sAML with antecedent MDS/MPN and that MAC is a suitable conditioning regimen in patients with sAML.

Original languageEnglish
Pages (from-to)2127-2135
Number of pages9
JournalBlood Advances
Volume2
Issue number16
DOIs
Publication statusPublished - 28 Aug 2018

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