Combination of cytogenetic classification and MRD status correlates with outcome of autologous versus allogeneic stem cell transplantation in adults with primary acute myeloid leukemia in first remission

Zhang, Guixin; Liang, Chen; Li, Gang; Chen, Xin; Ma, Qingyan; Zhai, Weihua; Yang, Donglin; He, Yi; Jiang, Erlie; Feng, Sizhou; Han, Mingzhe

doi:10.1016/j.leukres.2017.01.026

Cited by 24 publications

(38 citation statements)

References 26 publications

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“…Another study conducted by Balsat et al showed that a 4‐log reduction in NPM1 level after one cycle of chemotherapy was significantly associated with a good outcome, independently of the FLT3 mutational status. They also showed that allo‐SCT was able to significantly improve survival in patient with poor molecular response, which has been confirmed in another report . However, in our cohort of 102 patients with complete molecular response, we still found a significant benefit of MSD‐SCT over other transplant strategies.…”

Section: Discussionsupporting

confidence: 87%

Hematopoietic stem cell transplantation for adult patients with isolated NPM1 mutated acute myeloid leukemia in first remission

et al. 2018

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Acute myeloid leukemia (AML) in first remission (CR1) with isolated NPM1 mutation (iNPM1m) is considered a good prognosis genotype, although up to one-third relapse. To evaluate the best transplant strategy, we retrospectively compared autologous stem cell transplantation (auto-SCT), related (MSD), and fully matched unrelated (MUD) allogeneic stem cell transplantation (allo-SCT). We identified 256 adult patients including 125 auto-SCT, 72 MSD, and 59 MUD.The 2-year leukemia-free survival (LFS) was 62% in auto-SCT, 69% in MUD, and 81% in MSD (P = .02 for MSD vs others). The 2-year overall survival (OS) was not different among auto-SCT, MUD, and MSD, reaching 83% (P = .88). The 2-year non-relapse mortality (NRM) was 2.5% in auto-SCT and 7.5% in allo-SCT (P = .04). The 2-year cumulative incidence of relapse (RI) was higher after auto-SCT (30%) than after MUD (22%) and MSD (12%, P = .01). In multivariate analysis, MSD versus auto-SCT but not MUD versus auto-SCT was associated with lower RI (P < .01 Mohamad Mohty, Jordi Esteve, and Arnon Nagler contributed equally to this study.

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Section: Discussionsupporting

confidence: 87%

Hematopoietic stem cell transplantation for adult patients with isolated NPM1 mutated acute myeloid leukemia in first remission

et al. 2018

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“…In one study [30], patients with wild-type NPM1(NPM1 wt ) without FLT3-ITD or with a low allelic burden of FLT3-ITD (< 0.5) were considered as intermediate-risk group because of similar OS and RFS at 5 years. In the other 3 studies, their intermediate-risk AML were FLT3-ITD wild-type (FLT3-ITD wt ) and NPM1 wt [17, 31, 32]. On the basis of whether data on FLT3-ITD were available or not, we divided the included studies into two subgroups: FLT3-ITD wt and FLT3-ITD unknown (FLT3-ITD uk ).…”

Section: Resultsmentioning

confidence: 99%

“…In the intermediate-1 group, which included AML with FLT3-ITD mut , autoSCT was inferior to alloSCT for RFS (39 vs. 70%, p < 10 –6 ) and OS (61 vs. 74%, p = 0.005). In the other study [31], patients were stratified on the basis of cytogenetic and molecular abnormalities as well as MRD status. For patients with favorable and intermediate risks and negative MRD after one course of consolidation chemotherapy, autoSCT and alloSCT offered comparable outcomes; otherwise, autoSCT was inferior owing to a higher risk of leukemia relapse.…”

Section: Discussionmentioning

confidence: 99%

Autologous Stem Cell Transplantation Is a Viable Postremission Therapy for Intermediate-Risk Acute Myeloid Leukemia in First Complete Remission in the Absence of a Matched Identical Sibling: A Meta-Analysis

Liu

Wang

et al. 2019

Acta Haematol

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Background: The preferred type of postremission therapy (PRT) for intermediate-risk acute myeloid leukemia (AML) in first complete remission (CR1) is a subject of continued debate. Although allogeneic stem cell transplantation (alloSCT) is regarded as a curative strategy for AML, the efficacy of autologous stem cell transplantation (autoSCT) for patients without a matched sibling donor (MSD) has remained controversial. Methods: To compare survival outcomes after alloSCT versus autoSCT for patients with intermediate-risk AML in CR1, we performed a meta-analysis of 11 clinical studies. The outcomes included relapse-free survival (RFS), overall survival (OS), relapse rate (RR), and treatment-related mortality (TRM). Results: Compared with autoSCT, alloSCT showed better RFS, OS, and RR benefits, but higher TRM. Subgroup analysis based on donor category (MSD and matched unrelated donor [MUD]) of alloSCT showed alloSCT from MSD rather than from MUD had better OS benefits compared to autoSCT. For fms-like tyrosine kinase 3 internal tandem duplications (FLT3-ITD) wild-type patients, alloSCT and autoSCT had comparable RFS and OS outcomes. Conclusion: Our results suggest that, in the absence of an available MSD, autoSCT remains a viable PRT alternative for intermediate-risk AML in CR1, especially for FLT3-ITD wild-type patients.

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“…In 2 prospective HOVON-SAKK phase III trials, comparable OS was observed in patients with intermediaterisk AML following ASCT and allo-SCT in CR1 [5]. In a retrospective study of 172 patients with AML in CR1, OS and disease-free survival (DFS) did not differ significantly between patients who underwent ASCT and those who underwent MSD-allo-SCT [18]. Mizutani et al [12] evaluated survival outcomes after autologous peripheral blood stem cell transplantation (n = 357) and MSD-allo-SCT from bone marrow (n = 521) or peripheral blood (n = 380) in patients with AML in CR1 and found that although RR after ASCT was relatively higher, NRM was significantly lower compared with MSD-allo-SCT, and LFS did not differ significantly in multivariate analyses.…”

Section: Asct Versus Allo-sctmentioning

confidence: 98%

“…Yoon et al [21] reported similar outcomes in 240 patients with AML in CR1 who underwent ASCT following a conditioning regimen including total body irradiation (TBI; 1200 cGy), cytarabine (9 g/m 2 ), and melphalan (100 mg/m 2 ); OS decreased as the cytogenetic risk increased at 5 years after ASCT, with the highest 5-year OS in 19 patients carrying t(8;21) with isolated Y chromosome loss. In a previous study, we identified cytogenetic risk as an independent prognostic factor for survival outcomes, with decreasing OS and DFS as risk increased [18]. Gorin et al [3] compared ASCT with MUD-allo-SCT in patients with AML in CR1 and showed that favorable-risk patients benefited more from ASCT, intermediate-risk 2 patients had comparable outcomes after ASCT or MUD-allo-SCT, and intermediate-risk 1 patients had superior clinical outcomes after allo-SCT.…”

Section: Cytogenetic and Molecular Risk Stratificationmentioning

confidence: 98%

Autologous Hematopoietic Stem Cell Transplantation in Acute Myelogenous Leukemia

Zhao

Chen

Feng

2019

Biology of Blood and Marrow Transplantation

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The clinical outcomes of autologous hematopoietic stem cell transplantation (ASCT) in acute myelogenous leukemia (AML) have improved over time. Indeed, numerous studies have demonstrated that ASCT is associated with a lower relapse rate and acceptable nonrelapse mortality compared with chemotherapy alone in patients with AML. In addition, ASCT is also associated with comparable overall survival outcomes to those of allogeneic hematopoietic stem cell transplantation in some patients with AML. To date, age, cytogenetic and molecular risk stratification, and minimal residual disease (MRD) status have been shown to be closely related to clinical outcomes following ASCT. ASCT is recommended for patients with favorable-risk and intermediate-risk AML in first complete remission and patients with acute promyelocytic leukemia in second complete remission for whom a matched sibling donor is not available. MRD status pre-ASCT is the most important factor to consider when determining whether a patient is eligible for ASCT and can effectively predict clinical outcomes after ASCT. Advanced age is not an absolute contradiction for ASCT. In this review, we describe the literature and clinical trials evaluating the outcomes of ASCT in patients with AML and discuss the indications for ASCT therapy. Because the greatest concern in ASCT recipients is early relapse, important factors that should be monitored before ASCT and future perspectives in this area are also presented.

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Combination of cytogenetic classification and MRD status correlates with outcome of autologous versus allogeneic stem cell transplantation in adults with primary acute myeloid leukemia in first remission

Cited by 24 publications

References 26 publications

Hematopoietic stem cell transplantation for adult patients with isolated NPM1 mutated acute myeloid leukemia in first remission

Hematopoietic stem cell transplantation for adult patients with isolated NPM1 mutated acute myeloid leukemia in first remission

Autologous Stem Cell Transplantation Is a Viable Postremission Therapy for Intermediate-Risk Acute Myeloid Leukemia in First Complete Remission in the Absence of a Matched Identical Sibling: A Meta-Analysis

Autologous Hematopoietic Stem Cell Transplantation in Acute Myelogenous Leukemia

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