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Randomized Controlled Trial
. 2012 Feb;18(2):280-8.
doi: 10.1016/j.bbmt.2011.07.024. Epub 2011 Jul 31.

Classifying cytogenetics in patients with acute myelogenous leukemia in complete remission undergoing allogeneic transplantation: a Center for International Blood and Marrow Transplant Research study

Philippe Armand  1 , Haesook T Kim, Mei-Jie Zhang, Waleska S Perez, Paola S Dal Cin, Thomas R Klumpp, Edmund K Waller, Mark R Litzow, Jane L Liesveld, Hillard M Lazarus, Andrew S Artz, Vikas Gupta, Bipin N Savani, Philip L McCarthy, Jean-Yves Cahn, Harry C Schouten, Jürgen Finke, Edward D Ball, Mahmoud D Aljurf, Corey S Cutler, Jacob M Rowe, Joseph H Antin, Luis M Isola, Paolo Di Bartolomeo, Bruce M Camitta, Alan M Miller, Mitchell S Cairo, Keith Stockerl-Goldstein, Jorge Sierra, M Lynn Savoie, Joerg Halter, Patrick J Stiff, Chadi Nabhan, Ann A Jakubowski, Donald W Bunjes, Effie W Petersdorf, Steven M Devine, Richard T Maziarz, Martin Bornhauser, Victor A Lewis, David I Marks, Christopher N Bredeson, Robert J Soiffer, Daniel J Weisdorf
Affiliations
Randomized Controlled Trial

Classifying cytogenetics in patients with acute myelogenous leukemia in complete remission undergoing allogeneic transplantation: a Center for International Blood and Marrow Transplant Research study

Philippe Armand et al. Biol Blood Marrow Transplant. 2012 Feb.

Abstract

Cytogenetics play a major role in determining the prognosis of patients with acute myelogenous leukemia (AML). However, existing cytogenetics classifications were developed in chemotherapy-treated patients and might not be optimal for patients undergoing allogeneic hematopoietic cell transplantation (HCT). We studied 821 adult patients reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) who underwent HCT for AML in first or second complete remission between 1999 and 2004. We compared the ability of the 6 existing classifications to stratify patients by overall survival. We then defined a new scheme specifically applicable to patients undergoing HCT using this patient cohort. Under this scheme, inv(16) is favorable, a complex karyotype (4 or more abnormalities) is adverse, and all other classified abnormalities are intermediate in predicting survival after HCT (5-year overall survival, 64%, 18%, and 50%, respectively; P = .0001). This scheme stratifies patients into 3 groups with similar nonrelapse mortality, but significantly different incidences of relapse, overall and leukemia-free survival. It applies to patients regardless of disease status (first or second complete remission), donor type (matched related or unrelated), or conditioning intensity (myeloablative or reduced intensity). This transplantation-specific classification could be adopted for prognostication purposes and to stratify patients with AML and karyotypic abnormalities entering HCT clinical trials.

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Figures

Figure 1
Figure 1. Transplantation outcomes for patients classified by the CIBMTR grouping schema
(A) Overall survival; (B) Leukemia-free survival; (C) Cumulative incidence of relapse; (D) Cumulative incidence of non-relapse mortality.
Figure 2
Figure 2. Overall survival of patients classified according to the CIBMTR schema, stratified by disease status
(A) Patients transplanted in CR1; (B) Patients transplanted in CR2.
Figure 3
Figure 3. Overall survival of patients classified according to the CIBMTR schema, stratified by donor type
(A) Patients transplanted from a matched sibling donor; (B) Patients transplanted from an unrelated donor.
Figure 4
Figure 4. Overall survival of patients classified according to the CIBMTR schema, stratified by conditioning intensity
(A) Patients transplanted with myeloablative conditioning; (B) Patients transplanted with reduced intensity conditioning.
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