Long-term outcomes in patients with high-risk myeloid malignancies following matched related donor hematopoietic cell transplantation with myeloablative conditioning of BU, etoposide and CY

Abstract

Patients with high-risk or advanced myeloid malignancies have limited effective treatment options. These include high-dose therapy followed by allogeneic hematopoietic cell transplantation (HCT). We report a single-institution, long-term follow-up of 96 patients, median age 50 (range, 20-60) years, who received HLA-matched related HCT between 1992 and 2007. All patients were treated with a uniform preparatory regimen intended to enhance the widely used regimen of BU and CY that included: BU 16.0 mg/kg (days -8 to -5), etoposide 60 mg/kg (day -4), CY 60 mg/kg (day -2) with GVHD prophylaxis of CsA or FK506 and prednisone. Disease status at transplantation was high-risk AML (n=41), CML in second chronic phase or blast crisis (n=8), myelofibrosis and myeloproliferative disorders (n=8), and myelodysplasia (n=39). Thirty-six percent (n=35) of patients received BM whereas 64% (n=61) received G-CSF-mobilized PBPC. With a median follow-up of 5.6 years (range, 1.6-14.6 years) actuarial 5-year OS was 32% (95% CI 22-42) and 5-year EFS was 31% (95% CI 21-41). Relapse rate was 24% (95% CI 15-33) at 2 and 5 years. Nonrelapse mortality was 29% (95% CI 20-38) at day 100 and 38% (95% CI 29-47) at 1 year. Cumulative incidence of acute (grade II-IV) and extensive chronic GVHD was 27% (95% CI 18-36) and 29% (95% CI 18-40), respectively. There was no statistically significant difference in OS (31 vs 32%, P=0.89) or relapse rates (17 vs 28%, P=0.22) for recipients of BM vs PBPC, respectively. These results confirm that patients with high-risk or advanced myeloid malignancies can achieve long-term survival following myeloablative allogeneic HCT with aggressive conditioning.

Figure 1

(a) Cumulative incidence of acute GVHD receiving matched sibling donor allogeneic hematopoietic cell transplantation with BU/VP-16/CY myeloablative conditioning. (b) Cumulative incidence of chronic GVHD receiving matched sibling donor allogeneic hematopoietic cell transplantation with BU/VP-16/CY myeloablative conditioning.

Figure 2

(a) Kaplan–Meier estimates of OS and EFS in all 96 patients receiving matched sibling donor allogeneic hematopoietic cell transplantation with BU/VP-16/CY myeloablative conditioning. (b) Cumulative incidence of relapse in all 96 patients receiving matched sibling donor allogeneic hematopoietic cell transplantation with BU/VP-16/CY myeloablative conditioning. (c) Kaplan–Meier estimates of OS in different diagnostic categories. (d) Kaplan–Meier estimates of EFS in different diagnostic categories. Abbreviations: MF, myelofibrosis; MPD, myeloproliferative disorder; CML BC, CML in blast crisis; MDS, myelodysplastic syndromes; t-MDS/t-AML, therapy-related MDS/AML.

Figure 3

(a) Kaplan–Meier estimates of OS in all 96 patients receiving matched sibling donor allogeneic hematopoietic cell transplantation with BU/VP-16/CY myeloablative conditioning according to blast percentage (b). Kaplan-Meier estimates of EFS in all 96 patients receiving matched sibling donor allogeneic hematopoietic cell transplantation with BU/VP-16/CY myeloablative conditioning according to blast percentage.