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Multicenter Study
. 2020 Jan;105(1):161-169.
doi: 10.3324/haematol.2018.208678. Epub 2019 Apr 19.

Allogeneic hematopoietic cell transplantation improves outcome of adults with t(6;9) acute myeloid leukemia: results from an international collaborative study

Sabine Kayser  1   2 , Robert K Hills  3 , Marlise R Luskin  4 , Andrew M Brunner  5 , Christine Terré  6 , Jörg Westermann  7 , Kamal Menghrajani  8 , Carole Shaw  9   10 , Maria R Baer  11   12 , Michelle A Elliott  13 , Alexander E Perl  14 , Zdeněk Ráčil  15 , Jiri Mayer  15 , Pavel Zak  16 , Tomas Szotkowski  17 , Stéphane de Botton  18 , David Grimwade  19 , Karin Mayer  20 , Roland B Walter  9   10   21 , Alwin Krämer  22   2 , Alan K Burnett  3 , Anthony D Ho  22 , Uwe Platzbecker  23 , Christian Thiede  24 , Gerhard Ehninger  24 , Richard M Stone  4 , Christoph Röllig  24 , Martin S Tallman  8 , Elihu H Estey  9   10 , Carsten Müller-Tidow  22 , Nigel H Russell  25 , Richard F Schlenk  26 , Mark J Levis  27
Affiliations
Multicenter Study

Allogeneic hematopoietic cell transplantation improves outcome of adults with t(6;9) acute myeloid leukemia: results from an international collaborative study

Sabine Kayser et al. Haematologica. 2020 Jan.

Abstract

Acute myeloid leukemia (AML) with t(6;9)(p22;q34) is a distinct entity accounting for 1-2% of AML cases. A substantial proportion of these patients have a concomitant FLT3-ITD. While outcomes are dismal with intensive chemotherapy, limited evidence suggests allogeneic hematopoietic cell transplantation (allo-HCT) may improve survival if performed early during first complete remission. We report on a cohort of 178 patients with t(6;9)(p22;q34) within an international, multicenter collaboration. Median age was 46 years (range: 16-76), AML was de novo in 88%, FLT3-ITD was present in 62%, and additional cytogenetic abnormalities in 21%. Complete remission was achieved in 81% (n=144), including 14 patients who received high-dose cytarabine after initial induction failure. With a median follow up of 5.43 years, estimated overall survival at five years was 38% (95%CI: 31-47%). Allo-HCT was performed in 117 (66%) patients, including 89 in first complete remission. Allo-HCT in first complete remission was associated with higher 5-year relapse-free and overall survival as compared to consolidation chemotherapy: 45% (95%CI: 35-59%) and 53% (95%CI: 42-66%) versus 7% (95%CI: 3-19%) and 23% (95%CI: 13-38%), respectively. For patients undergoing allo-HCT, there was no difference in overall survival rates at five years according to whether it was performed in first [53% (95%CI: 42-66%)], or second [58% (95%CI: 31-100%); n=10] complete remission or with active disease/relapse [54% (95%CI: 34-84%); n=18] (P=0.67). Neither FLT3-ITD nor additional chromosomal abnormalities impacted survival. In conclusion, outcomes of t(6;9)(p22;q34) AML are poor with chemotherapy, and can be substantially improved with allo-HCT.

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Figures

Figure 1.
Figure 1.
Cumulative incidence of relapse (CIR) and cumulative incidence of death (CID) according to treatment strategy. CIR and CID included only patients achieving complete remission.
Figure 2.
Figure 2.
Simon Makuch plot evaluating the impact of allogeneic hematopoietic cell transplantation (allo-HCT) assessed as a time-dependent co-variable in comparison with chemotherapy consolidation on overall survival.
Figure 3.
Figure 3.
Kaplan Meier plot illustrating the influence of allogeneic hematopoietic cell transplantation (allo-HCT) performed in first complete remission on relapse-free survival.
Figure 4.
Figure 4.
Overall survival after allogeneic hematopoietic cell transplantation according to remission status.
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