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Comparative Study
. 2010 Jun;95(6):989-95.
doi: 10.3324/haematol.2009.013920. Epub 2009 Nov 30.

Factors predicting long-term survival after T-cell depleted reduced intensity allogeneic stem cell transplantation for acute myeloid leukemia

Charles Craddock  1 , Sandeep Nagra, Andrew Peniket, Cassandra Brookes, Laura Buckley, Emmanouil Nikolousis, Nick Duncan, Sudhir Tauro, John Yin, Effie Liakopoulou, Panos Kottaridis, John Snowden, Donald Milligan, Gordon Cook, Eleni Tholouli, Tim Littlewood, Karl Peggs, Paresh Vyas, Fiona Clark, Mark Cook, Stephen Mackinnon, Nigel Russell
Affiliations
Comparative Study

Factors predicting long-term survival after T-cell depleted reduced intensity allogeneic stem cell transplantation for acute myeloid leukemia

Charles Craddock et al. Haematologica. 2010 Jun.

Abstract

Background: Reduced intensity conditioning regimens permit the delivery of a potentially curative graft-versus-leukemia effect in older patients with acute myeloid leukemia. Although T-cell depletion is increasingly used to reduce the risk of graft-versus-host disease its impact on the graft-versus-leukemia effect and long-term outcome post-transplant is unknown.

Design and methods: We have characterized pre- and post-transplant factors determining overall survival in 168 patients with acute myeloid leukemia transplanted using an alemtuzumab based reduced intensity conditioning regimen with a median duration of follow-up of 37 months.

Results: The 3-year overall survival for patients transplanted in CR1 or CR2/CR3 was 50% (95% CI, 38% to 62%) and 44% (95% CI, 31% to 56%), respectively compared to 15% (95% CI, 2% to 36%) for patients with relapsed/refractory disease. Multivariate analysis demonstrated that both survival and disease relapse were influenced by status at transplant (P=0.008) and presentation cytogenetics (P=0.01). Increased exposure to cyclosporine A (CsA) in the first 21 days post-transplant was associated with an increased relapse risk (P<0.0001) and decreased overall survival (P<0.0001).

Conclusions: Disease stage, presentation karyotype and post-transplant CsA exposure are important predictors of outcome in patients undergoing a T-cell depleted reduced intensity conditioning allograft for acute myeloid leukemia. These data confirm the presence of a potent graft-versus-leukemia effect after a T-cell depleted reduced intensity conditioning allograft in acute myeloid leukemia and identify CsA exposure as a manipulable determinant of outcome in this setting.

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Figures

Figure 1.
Figure 1.
(A) Overall survival after an alemtuzumab based RIC allograft for acute myeloid leukemia according to disease status at the time of transplant. (B) Overall survival according to cytogenetic risk classification at diagnosis.
Figure 2.
Figure 2.
(A) Impact of cytogenetic status at presentation on relapse incidence and relapse kinetics after an alemtuzumab based RIC allograft for acute myeloid leukemia. (B) Impact of disease status at time of transplantation on relapse incidence and relapse kinetics.
Figure 3.
Figure 3.
Overall survival according to CsA21 (above or below mean CsA exposure) in 63 patients undergoing RIC allograft for acute myeloid leukemia.
See this image and copyright information in PMC

Comment in

References

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