Allogeneic Hematopoietic Cell Transplantation for Adult Chronic Myelomonocytic Leukemia

Hien Duong Liu¹, Kwang Woo Ahn², Zhen-Huan Hu³, Mehdi Hamadani³, Taiga Nishihori⁴, Baldeep Wirk⁵, Amer Beitinjaneh⁶, David Rizzieri⁷, Michael R Grunwald⁸, Mitchell Sabloff⁹, Richard F Olsson¹⁰, Ashish Bajel¹¹, Christopher Bredeson¹², Andrew Daly¹³, Yoshihiro Inamoto¹⁴, Navneet Majhail¹⁵, Ayman Saad¹⁶, Vikas Gupta¹⁷, Aaron Gerds¹⁸, Adriana Malone¹⁹, Martin Tallman²⁰, Ran Reshef²¹, David I Marks²², Edward Copelan⁸, Usama Gergis²³, Mary Lynn Savoie²⁴, Celalettin Ustun²⁵, Mark R Litzow²⁶, Jean-Yves Cahn²⁷, Tamila Kindwall-Keller²⁸, Gorgun Akpek²⁹, Bipin N Savani³⁰, Mahmoud Aljurf³¹, Jacob M Rowe³², Peter H Wiernik³³, Jack W Hsu³⁴, Jorge Cortes³⁵, Matt Kalaycio³⁶, Richard Maziarz³⁷, Ronald Sobecks³⁶, Uday Popat³⁸, Edwin Alyea³⁹, Wael Saber³

Affiliations

¹ Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio. Electronic address: liuh@ccf.org.
² Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
³ Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
⁴ Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
⁵ Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington.
⁶ Department of Hematology and Oncology, University of Miami Sylvester Cancer Center, Miami, Florida.
⁷ Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina.
⁸ Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
⁹ Division of Hematology, Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada.
¹⁰ Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden.
¹¹ Department of Haematology and Bone Marrow Transplant, Royal Melbourne Hospital, Victoria, Australia.
¹² The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹³ Department of Medicine, Tom Baker Cancer Centre, Calgary, Canada; Department of Oncology, Tom Baker Cancer Centre, Calgary, Canada.
¹⁴ Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
¹⁵ Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
¹⁶ Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
¹⁷ Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
¹⁸ Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
¹⁹ Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
²⁰ Leukemia Service, Department of Medicine, Memorial Sloan, New York, New York.
²¹ Blood and Marrow Transplantation Program and Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York.
²² Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
²³ Hematologic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
²⁴ Division of Hematology and Hematologic Malignancies, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
²⁵ Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
²⁶ Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, Minnesota.
²⁷ Department of Hematology, University Hospital, Grenoble, France.
²⁸ Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia.
²⁹ Stem Cell Transplantation and Cellular Therapy Program, Banner MD Anderson Cancer Center, Gilbert, Arizona.
³⁰ Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
³¹ Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia.
³² Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel.
³³ Our Lady of Mercy Medical Center, Bronx, New York.
³⁴ Division of Hematology and Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, Florida.
³⁵ Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
³⁶ Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Cleveland, Ohio.
³⁷ Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.
³⁸ Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, Texas.
³⁹ Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.

PMID: 28115276
PMCID: PMC5590102
DOI: 10.1016/j.bbmt.2017.01.078

Allogeneic Hematopoietic Cell Transplantation for Adult Chronic Myelomonocytic Leukemia

Hien Duong Liu et al. Biol Blood Marrow Transplant. 2017 May.

. 2017 May;23(5):767-775.

doi: 10.1016/j.bbmt.2017.01.078. Epub 2017 Jan 20.

Authors

Affiliations

¹ Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio. Electronic address: liuh@ccf.org.
² Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
³ Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
⁴ Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
⁵ Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington.
⁶ Department of Hematology and Oncology, University of Miami Sylvester Cancer Center, Miami, Florida.
⁷ Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina.
⁸ Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.
⁹ Division of Hematology, Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada.
¹⁰ Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden.
¹¹ Department of Haematology and Bone Marrow Transplant, Royal Melbourne Hospital, Victoria, Australia.
¹² The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹³ Department of Medicine, Tom Baker Cancer Centre, Calgary, Canada; Department of Oncology, Tom Baker Cancer Centre, Calgary, Canada.
¹⁴ Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
¹⁵ Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
¹⁶ Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
¹⁷ Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
¹⁸ Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
¹⁹ Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
²⁰ Leukemia Service, Department of Medicine, Memorial Sloan, New York, New York.
²¹ Blood and Marrow Transplantation Program and Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York.
²² Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
²³ Hematologic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
²⁴ Division of Hematology and Hematologic Malignancies, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
²⁵ Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
²⁶ Division of Hematology and Transplant Center, Mayo Clinic Rochester, Rochester, Minnesota.
²⁷ Department of Hematology, University Hospital, Grenoble, France.
²⁸ Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia.
²⁹ Stem Cell Transplantation and Cellular Therapy Program, Banner MD Anderson Cancer Center, Gilbert, Arizona.
³⁰ Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
³¹ Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia.
³² Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel.
³³ Our Lady of Mercy Medical Center, Bronx, New York.
³⁴ Division of Hematology and Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, Florida.
³⁵ Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
³⁶ Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Cleveland, Ohio.
³⁷ Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.
³⁸ Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, Texas.
³⁹ Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.

PMID: 28115276
PMCID: PMC5590102
DOI: 10.1016/j.bbmt.2017.01.078

Abstract

Allogeneic hematopoietic cell transplantation (HCT) is potentially curative for patients with chronic myelomonocytic leukemia (CMML); however, few data exist regarding prognostic factors and transplantation outcomes. We performed this retrospective study to identify prognostic factors for post-transplantation outcomes. The CMML-specific prognostic scoring system (CPSS) has been validated in subjects receiving nontransplantation therapy and was included in our study. From 2001 to 2012, 209 adult subjects who received HCT for CMML were reported to the Center for International Blood and Marrow Transplant Research. The median age at transplantation was 57 years (range, 23 to 74). Median follow-up was 51 months (range, 3 to 122). On multivariate analyses, CPSS scores, Karnofsky performance status (KPS), and graft source were significant predictors of survival (P = .004, P = .01, P = .01, respectively). Higher CPSS scores were not associated with disease-free survival, relapse, or transplantation-related mortality. In a restricted analysis of subjects with relapse after HCT, those with intermediate-2/high risk had a nearly 2-fold increased risk of death after relapse compared to those with low/intermediate-1 CPSS scores. Respective 1-year, 3-year, and 5-year survival rates for low/intermediate-1 risk subjects were 61% (95% confidence interval [CI], 52% to 72%), 48% (95% CI, 37% to 59%), and 44% (95% CI, 33% to 55%), and for intermediate-2/high risk subjects were 38% (95% CI, 28% to 49%), 32% (95% CI, 21% to 42%), and 19% (95% CI, 8% to 29%). We conclude that higher CPSS score at time of transplantation, lower KPS, and a bone marrow graft are associated with inferior survival after HCT. Further investigation of CMML disease-related biology may provide insights into other risk factors predictive of post-transplantation outcomes.

Keywords: Allogeneic hematopoietic cell transplantation; Chronic myelomonocytic leukemia; Transplantation outcomes.

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Figures

**Figure 1**
Adjusted disease free survival and overall survival, starting at the time of transplant, by HCT Specific CPSS

**Figure 2**
Adjusted disease free survival and overall survival, starting at the time of transplant, by HCT Specific CPSS

See this image and copyright information in PMC

Comment in

A Lot to Learn about Allogeneic Hematopoietic Cell Transplantation for Chronic Myelomonocytic Leukemia.
Sanz GF. Sanz GF. Biol Blood Marrow Transplant. 2017 May;23(5):713-714. doi: 10.1016/j.bbmt.2017.03.011. Epub 2017 Mar 9. Biol Blood Marrow Transplant. 2017. PMID: 28286197 No abstract available.

References

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Allogeneic Hematopoietic Cell Transplantation for Adult Chronic Myelomonocytic Leukemia

Affiliations

Allogeneic Hematopoietic Cell Transplantation for Adult Chronic Myelomonocytic Leukemia

Authors

Affiliations

Abstract

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References

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