Outcome of high-risk acute myeloid leukemia after allogeneic hematopoietic cell transplantation: negative impact of abnl(17p) and -5/5q-
Jan M Middeke, Dietrich Beelen, Michael Stadler, Gudrun Göhring, Brigitte Schlegelberger, Herrad Baurmann, Gesine Bug, Frauke Bellos, Brigitte Mohr, Stefanie Buchholz, Rainer Schwerdtfeger, Hans Martin, Ute Hegenbart, Gerhard Ehninger, Martin Bornhäuser, Johannes Schetelig, Cooperative German Transplant Study Group, Jan M Middeke, Dietrich Beelen, Michael Stadler, Gudrun Göhring, Brigitte Schlegelberger, Herrad Baurmann, Gesine Bug, Frauke Bellos, Brigitte Mohr, Stefanie Buchholz, Rainer Schwerdtfeger, Hans Martin, Ute Hegenbart, Gerhard Ehninger, Martin Bornhäuser, Johannes Schetelig, Cooperative German Transplant Study Group
Abstract
The European LeukemiaNet classification combines a heterogeneous group of aberrations as adverse-risk abnormalities. Our goal was to investigate the outcomes associated with distinct high-risk chromosomal abnormalities in acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (HSCT). We performed a retrospective cohort analysis in patients with high-risk AML who received first, HLA-compatible, allogeneic HSCT between January 2005 and December 2008. Data from 236 patients with a median age of 55 years were included. Because complex karyotype (CK), -5/5q-, and abnl(17p) are overlapping categories, a hierarchical classification system based on the presence or absence of abnl(17p) and -5/5q- was developed. Patients with abnl(17p) had a 2-year event-free survival (EFS) of 11% (95% confidence interval [CI], 0%-25%), patients with -5/5q- but no abnl(17p) a 2-year EFS of 29% (95% CI, 14%-44%), and patients with adverse-risk AML but neither of the 2 marker lesions a 2-year EFS of 49% (95% CI, 39%-59%). Notably, complex and monosomal karyotypes lost their prognostic value when these marker lesions were excluded. In conclusion, hierarchical classification of adverse-risk karyotypes by 2 marker lesions, abnl(17p) and -5/5q-, is effective in prognostication of the outcome of allogeneic HSCT in AML.
Source: PubMed