Comparison of outcomes of HCT in blast phase of BCR-ABL1- MPN with de novo AML and with AML following MDS
Gadalla, Shahinaz M
Gale, Robert Peter
Gerds, Aaron T
Hamilton, Betty K
Hildebrandt, Gerhard C
Kamble, Rammurti T
Lazarus, Hillard M
Liesveld, Jane L
Maziarz, Richard T
Olsson, Richard F
Savani, Bipin N
Verdonck, Leo F
Yared, Jean A
Alyea, Edwin P
Popat, Uday R
Sobecks, Ronald M
Scott, Bart L
PublisherAmerican Society of Hematology
MetadataShow full item record
AbstractComparative outcomes of allogeneic hematopoietic cell transplantation (HCT) for BCR-ABL12 myeloproliferative neoplasms (MPNs) in blast phase (MPN-BP) vs de novo acute myeloid leukemia (AML), and AML with prior myelodysplastic syndromes (MDSs; post-MDS AML), are unknown. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we compared HCT outcomes in 177 MPN-BP patients with 4749 patients with de novo AML, and 1104 patients with post-MDS AML, using multivariate regression analysis in 2 separate comparisons. In a multivariate Cox model, no difference in overall survival (OS) or relapse was observed in patients with MPN-BP vs de novo AML with active leukemia at HCT. Patients with MPN-BP in remission had inferior OS in comparison with de novo AML in remission (hazard ratio [HR], 1.40 [95% confidence interval [CI], 1.12-1.76]) due to higher relapse rate (HR, 2.18 [95% CI, 1.69-2.80]). MPN-BP patients had inferior OS (HR, 1.19 [95% CI, 1.00-1.43]) and increased relapse (HR, 1.60 [95% CI, 1.31-1.96]) compared with post-MDS AML. Poor-risk cytogenetics were associated with increased relapse in both comparisons. Peripheral blood grafts were associated with decreased relapse in MPN-BP and post-MDS AML (HR, 0.70 [95% CI, 0.57-0.86]). Nonrelapse mortality (NRM) was similar between MPN-BP vs de novo AML, and MPN-BP vs post-MDS AML. Total-body irradiation-based myeloablative conditioning was associated with higher NRM in both comparisons. Survival of MPN-BP after HCT is inferior to de novo AML in remission and post-MDS AML due to increased relapse. Relapse-prevention strategies are required to optimize HCT outcomes in MPN-BP.
SponsorsThe CIBMTR was supported primarily by Public Health Service U24CA076518 from the National Cancer Institute, the National Heart, Lung, and Blood Institute, and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health; U24HL138660 from the National Heart, Lung, and Blood Institute and National Cancer Institute; T3HL147741, R21HL140314, and U01HL128568 from the National Heart, Lung, and Blood Institute; HHSH250201700006C, SC1MC31881-01-00, and HHSH250201700007C from the Health Resources and Services Administration; and N00014-18-1-2850, N00014-18-1-2888, and N00014-20-1-2705 from the Office of Naval Research. Additional federal support was provided by P01CA111412, R01CA152108, R01CA215134, R01CA218285, and R01CA231141 from the National Cancer Institute; R01HL126589 from the National Heart, Lung, and Blood Institute; R01AI128775 from the National Institute of Allergy and Infectious Diseases; R01HL129472, R01HL130388, and R01HL131731 from the National Heart, Lung, and Blood Institute; U01AI069197 and U01AI126612 from the National Institute of Allergy and Infectious Diseases; and Biomedical Advanced Research and Development Authority.
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/13905
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