Outcomes of allogeneic stem cell transplantation among patients with acute myeloid leukemia presenting active disease: Experience of a single European Comprehensive Cancer Center

Abstract

OutcOmes Of allOgeneic stem cell transplantatiOn amOng patients with acute myelOid leukemia presenting active disease: experience Of a single eurOpean cOmprehensive cancer center rev assoC med bras 2016; 62 (7) Introduction: Allogeneic hematopoietic stem cell transplantation (ASCT) represents a potentially curative approach for patients with relapsed or refractory acute myeloid leukemia (AML). We report the outcome of relapsed/refractory AML patients treated with ASCT. Method: A retrospective cohort from 1994 to 2013 that included 61 patients with diagnosis of relapsed/refractory AML. Outcomes of interest were transplant--related mortality (TRM), incidence of acute and chronic graft-versus-host disease (GVHD), relapse incidence, progression-free survival (PFS) and overall survival (OS). Statistical significance was set at p<0.05. Results:The median age was 61 years (range 1 to 65). The cumulative incidence of 90 days, 1 year, and 3 years TRM were 60%, 26.7%, and 13.3%, respectively (p<0.001). The incidence of relapse was 21.7% at 1 year, 13% at 3 years, and 8.7% at 5 years. Median OS was estimated to be 8 months ) and median PFS, 3 months (95CI 1.835-4.165). Conclusion:In our cohort, TRM in first years after ASCT remains considerable, but ASCT in this setting seems to be a good choice for AML patients with active disease. However, novel approaches are needed to reduce TRM and relapse in this set of patients.

Outcome of allogeneic stem cell transplantation with active disease in acute myeloid leukemia

“…TRM was 47.6% in the same study. In our study relapse was observed in 10 of 31 patients (32.2%) during the first 90 days after transplantation, found to be similar (OS 7.9 months vs 8 months and PFS 3.5 months vs 3 months) (13).…”

Desenvolvimento De Doenças E Complicações Após Transplante De Medula Óssea / Development of Disease and Subsequent Complications of Bone Marrow Trasnplantation

“…Infecções fúngicas estão mais relacionadas ao transplante alogênico que o autólogo, principalmente após o uso de corticosteroides e casos de DECH crônica. Esta última por sua contribuem para infecções de bactérias encapsuladas como Streptococcus pneumoniae ,Haemophilus influenzae e Neisseria meningitidis.14 O transplante de medula óssea alogênico vem sendo utilizado para o tratamento de portadores de HIV-AIDS, tanto para tentar uma cura da infecção, quanto por malignidades hematológicas que possam se apresentar nesses indivíduos.35 As complicações podem variar e estão muito relacionadas coma terapia anti-retroviral usada nesses pacientes, sendo mais comum as infecções oportunistas, viremias, cistites hemorrágicas, em alguns casos desenvolvimento de sarcoma de Kaposi, doença do enxerto contra o hospedeiro (DECH) e alterações hepáticas devido ao vírus da hepatite C.35 , recidiva da doença e mortalidade relacionada ao transplante elevada podem ser apresentadas por estes pacientes 36. O risco de morte pós o transplante alogênico tanto para LMA quanto para a Síndrome Mielodisplásica é alto, principalmente relacionada a doença do enxerto contra o hospedeiro e infecções virais e fúngicas 37.…”