Impact of primary disease on outcome after allogeneic stem cell transplantation for transformed secondary acute leukaemia

on behalf of the Chronic Malignancies Working Party of the European Society for Blood Marrow Transplantation

Research output: Article

Abstract

Myelodysplastic syndromes (MDS), myeloproliferative neoplasms (MPN) and chronic myelomonocytic leukaemia (CMML) can progress to secondary acute myeloid leukaemia (sAML). We compared the outcome of 4214 sAML patients who received allogeneic haematopoietic stem cell transplantation (allo-HSCT) from an unrelated (62%) or human leucocyte antigen (HLA)-identical sibling donor (38%) according the underlying disease: MDS (n = 3541), CMML (n = 251) or MPN (n = 422). After a median follow up of 46·5 months, the estimated 3-year progression-free (PFS) and overall survival (OS) for the entire group was 36% (34–37%) and 41% (40–43%), respectively. The cumulative incidence of relapse and non-relapse mortality (NRM) was 37% (35–39%) and 27% (26–29%), respectively. In a multivariable analysis for OS, besides age (P < 0·001), unrelated donor (P = 0·011), cytomegalovirus ± constellation (P = 0·007), Karnofsky index ≤ 80 (P < 0·001), remission status (P < 0·001), peripheral blood as stem cell source (P = 0·009), sAML from MPN (P = 0·003) remained a significant factor in comparison to sAML from MDS, while worse outcome of sAML from CMML did not reach statistical significance (P = 0·06). This large registry study demonstrates a major impact of the underlying disease on outcome of sAML after allo-HSCT.

Original languageEnglish
JournalBritish Journal of Haematology
DOIs
Publication statusPublished - jan. 1 2019

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Stem Cell Transplantation
Acute Myeloid Leukemia
Leukemia
Leukemia, Myelomonocytic, Chronic
Myelodysplastic Syndromes
Hematopoietic Stem Cell Transplantation
Neoplasms
Unrelated Donors
Survival Analysis
HLA Antigens
Cytomegalovirus
Registries
Siblings
Tissue Donors
Recurrence
Survival
Mortality
Incidence

ASJC Scopus subject areas

  • Hematology

Cite this

Impact of primary disease on outcome after allogeneic stem cell transplantation for transformed secondary acute leukaemia. / on behalf of the Chronic Malignancies Working Party of the European Society for Blood Marrow Transplantation.

In: British Journal of Haematology, 01.01.2019.

Research output: Article

on behalf of the Chronic Malignancies Working Party of the European Society for Blood Marrow Transplantation. Impact of primary disease on outcome after allogeneic stem cell transplantation for transformed secondary acute leukaemia. British Journal of Haematology. 2019 jan. 1. https://doi.org/10.1111/bjh.15819
on behalf of the Chronic Malignancies Working Party of the European Society for Blood Marrow Transplantation. / Impact of primary disease on outcome after allogeneic stem cell transplantation for transformed secondary acute leukaemia. In: British Journal of Haematology. 2019.
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abstract = "Myelodysplastic syndromes (MDS), myeloproliferative neoplasms (MPN) and chronic myelomonocytic leukaemia (CMML) can progress to secondary acute myeloid leukaemia (sAML). We compared the outcome of 4214 sAML patients who received allogeneic haematopoietic stem cell transplantation (allo-HSCT) from an unrelated (62{\%}) or human leucocyte antigen (HLA)-identical sibling donor (38{\%}) according the underlying disease: MDS (n = 3541), CMML (n = 251) or MPN (n = 422). After a median follow up of 46·5 months, the estimated 3-year progression-free (PFS) and overall survival (OS) for the entire group was 36{\%} (34–37{\%}) and 41{\%} (40–43{\%}), respectively. The cumulative incidence of relapse and non-relapse mortality (NRM) was 37{\%} (35–39{\%}) and 27{\%} (26–29{\%}), respectively. In a multivariable analysis for OS, besides age (P < 0·001), unrelated donor (P = 0·011), cytomegalovirus ± constellation (P = 0·007), Karnofsky index ≤ 80 (P < 0·001), remission status (P < 0·001), peripheral blood as stem cell source (P = 0·009), sAML from MPN (P = 0·003) remained a significant factor in comparison to sAML from MDS, while worse outcome of sAML from CMML did not reach statistical significance (P = 0·06). This large registry study demonstrates a major impact of the underlying disease on outcome of sAML after allo-HSCT.",
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author = "{on behalf of the Chronic Malignancies Working Party of the European Society for Blood Marrow Transplantation} and Nicolaus Kr{\"o}ger and Eikema, {Diderik Jan} and Linda K{\"o}ster and Dietrich Beelen and {de Wreede}, {Liesbeth C.} and J{\"u}rgen Finke and Christian Koenecke and Dietger Niederwieser and Martin Bornh{\"a}user and Stefan Schoenland and Victoria Potter and Christine Wolschke and Johan Maertens and Matthias Theobald and Guido Kobbe and Maija It{\"a}l{\"a}-Remes and Gerald Wulf and Peter Kahls and Edouard Forcade and Hildegard Greinix and T. Masszi and Ibrahim Yakoub-Agha and Yves Chalandon and Marie Robin",
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AU - on behalf of the Chronic Malignancies Working Party of the European Society for Blood Marrow Transplantation

AU - Kröger, Nicolaus

AU - Eikema, Diderik Jan

AU - Köster, Linda

AU - Beelen, Dietrich

AU - de Wreede, Liesbeth C.

AU - Finke, Jürgen

AU - Koenecke, Christian

AU - Niederwieser, Dietger

AU - Bornhäuser, Martin

AU - Schoenland, Stefan

AU - Potter, Victoria

AU - Wolschke, Christine

AU - Maertens, Johan

AU - Theobald, Matthias

AU - Kobbe, Guido

AU - Itälä-Remes, Maija

AU - Wulf, Gerald

AU - Kahls, Peter

AU - Forcade, Edouard

AU - Greinix, Hildegard

AU - Masszi, T.

AU - Yakoub-Agha, Ibrahim

AU - Chalandon, Yves

AU - Robin, Marie

PY - 2019/1/1

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N2 - Myelodysplastic syndromes (MDS), myeloproliferative neoplasms (MPN) and chronic myelomonocytic leukaemia (CMML) can progress to secondary acute myeloid leukaemia (sAML). We compared the outcome of 4214 sAML patients who received allogeneic haematopoietic stem cell transplantation (allo-HSCT) from an unrelated (62%) or human leucocyte antigen (HLA)-identical sibling donor (38%) according the underlying disease: MDS (n = 3541), CMML (n = 251) or MPN (n = 422). After a median follow up of 46·5 months, the estimated 3-year progression-free (PFS) and overall survival (OS) for the entire group was 36% (34–37%) and 41% (40–43%), respectively. The cumulative incidence of relapse and non-relapse mortality (NRM) was 37% (35–39%) and 27% (26–29%), respectively. In a multivariable analysis for OS, besides age (P < 0·001), unrelated donor (P = 0·011), cytomegalovirus ± constellation (P = 0·007), Karnofsky index ≤ 80 (P < 0·001), remission status (P < 0·001), peripheral blood as stem cell source (P = 0·009), sAML from MPN (P = 0·003) remained a significant factor in comparison to sAML from MDS, while worse outcome of sAML from CMML did not reach statistical significance (P = 0·06). This large registry study demonstrates a major impact of the underlying disease on outcome of sAML after allo-HSCT.

AB - Myelodysplastic syndromes (MDS), myeloproliferative neoplasms (MPN) and chronic myelomonocytic leukaemia (CMML) can progress to secondary acute myeloid leukaemia (sAML). We compared the outcome of 4214 sAML patients who received allogeneic haematopoietic stem cell transplantation (allo-HSCT) from an unrelated (62%) or human leucocyte antigen (HLA)-identical sibling donor (38%) according the underlying disease: MDS (n = 3541), CMML (n = 251) or MPN (n = 422). After a median follow up of 46·5 months, the estimated 3-year progression-free (PFS) and overall survival (OS) for the entire group was 36% (34–37%) and 41% (40–43%), respectively. The cumulative incidence of relapse and non-relapse mortality (NRM) was 37% (35–39%) and 27% (26–29%), respectively. In a multivariable analysis for OS, besides age (P < 0·001), unrelated donor (P = 0·011), cytomegalovirus ± constellation (P = 0·007), Karnofsky index ≤ 80 (P < 0·001), remission status (P < 0·001), peripheral blood as stem cell source (P = 0·009), sAML from MPN (P = 0·003) remained a significant factor in comparison to sAML from MDS, while worse outcome of sAML from CMML did not reach statistical significance (P = 0·06). This large registry study demonstrates a major impact of the underlying disease on outcome of sAML after allo-HSCT.

KW - allogeneic stem cell transplantation

KW - chronic myelomonocytic leukaemia

KW - MDS

KW - myeloproliferative neoplasm

KW - secondary acute myeloid leukaemia

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