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    Allogeneic Transplantation to Treat Therapy-Related Myelodysplastic Syndrome and Acute Myelogenous Leukemia in Adults

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    Authors
    Metheny, Leland
    Callander, Natalie S
    Hall, Aric C
    Zhang, Mei-Jei
    Bo-Subait, Khalid
    Wang, Hai-Lin
    Agrawal, Vaibhav
    Al-Homsi, A Samer
    Assal, Amer
    Bacher, Ulrike
    Beitinjaneh, Amer
    Bejanyan, Nelli
    Bhatt, Vijaya Raj
    Bredeson, Chris
    Byrne, Michael
    Cairo, Mitchell
    Cerny, Jan
    DeFilipp, Zachariah
    Perez, Miguel Angel Diaz
    Freytes, César O
    Ganguly, Siddhartha
    Grunwald, Michael R
    Hashmi, Shahrukh
    Hildebrandt, Gerhard C
    Inamoto, Yoshihiro
    Kanakry, Christopher G
    Kharfan-Dabaja, Mohamed A
    Lazarus, Hillard M
    Lee, Jong Wook
    Nathan, Sunita
    Nishihori, Taiga
    Olsson, Richard F
    Ringdén, Olov
    Rizzieri, David
    Savani, Bipin N
    Savoie, Mary Lynn
    Seo, Sachiko
    van der Poel, Marjolein
    Verdonck, Leo F
    Wagner, John L
    Yared, Jean A
    Hourigan, Christopher S
    Kebriaei, Partow
    Litzow, Mark
    Sandmaier, Brenda M
    Saber, Wael
    Weisdorf, Daniel
    de Lima, Marcos
    Show allShow less
    UMass Chan Affiliations
    Medicine
    Document Type
    Journal Article
    Publication Date
    2021-08-21
    Keywords
    Acute myelogenous leukemia
    Allogeneic transplantation
    Myelodysplasia
    
    Metadata
    Show full item record
    Link to Full Text
    https://doi.org/10.1016/j.jtct.2021.08.010
    Abstract
    Patients who develop therapy-related myeloid neoplasm, either myelodysplastic syndrome (t-MDS) or acute myelogenous leukemia (t-AML), have a poor prognosis. An earlier Center for International Blood and Marrow Transplant Research (CIBMTR) analysis of 868 allogeneic hematopoietic cell transplantations (allo-HCTs) performed between 1990 and 2004 showed a 5-year overall survival (OS) and disease-free survival (DFS) of 22% and 21%, respectively. Modern supportive care, graft-versus-host disease prophylaxis, and reduced-intensity conditioning (RIC) regimens have led to improved outcomes. Therefore, the CIBMTR analyzed 1531 allo-HCTs performed in adults with t-MDS (n = 759) or t-AML (n = 772) between and 2000 and 2014. The median age was 59 years (range, 18 to 74 years) for the patients with t-MDS and 52 years (range, 18 to 77 years) for those with t-AML. Twenty-four percent of patients with t-MDS and 11% of those with t-AML had undergone a previous autologous (auto-) HCT. A myeloablative conditioning (MAC) regimen was used in 49% of patients with t-MDS and 61% of patients with t-AML. Nonrelapse mortality at 5 years was 34% (95% confidence interval [CI], 30% to 37%) for patients with t-MDS and 34% (95% CI, 30% to 37%) for those with t-AML. Relapse rates at 5 years in the 2 groups were 46% (95% CI, 43% to 50%) and 43% (95% CI, 40% to 47%). Five-year OS and DFS were 27% (95% CI, 23% to 31%) and 19% (95% CI, 16% to 23%), respectively, for patients with t-MDS and 25% (95% CI, 22% to 28%) and 23% (95% CI, 20% to 26%), respectively, for those with t-AML. In multivariate analysis, OS and DFS were significantly better in young patients with low-risk t-MDS and those with t-AML undergoing HCT with MAC while in first complete remission, but worse for those with previous auto-HCT, higher-risk cytogenetics or Revised International Prognostic Scoring System score, and a partially matched unrelated donor. Relapse remains the major cause of treatment failure, with little improvement seen over the past 2 decades. These data mandate caution when recommending allo-HCT in these conditions and indicate the need for more effective antineoplastic approaches before and after allo-HCT.
    Source
    Metheny L, Callander NS, Hall AC, Zhang MJ, Bo-Subait K, Wang HL, Agrawal V, Al-Homsi AS, Assal A, Bacher U, Beitinjaneh A, Bejanyan N, Bhatt VR, Bredeson C, Byrne M, Cairo M, Cerny J, DeFilipp Z, Perez MAD, Freytes CO, Ganguly S, Grunwald MR, Hashmi S, Hildebrandt GC, Inamoto Y, Kanakry CG, Kharfan-Dabaja MA, Lazarus HM, Lee JW, Nathan S, Nishihori T, Olsson RF, Ringdén O, Rizzieri D, Savani BN, Savoie ML, Seo S, van der Poel M, Verdonck LF, Wagner JL, Yared JA, Hourigan CS, Kebriaei P, Litzow M, Sandmaier BM, Saber W, Weisdorf D, de Lima M. Allogeneic Transplantation to Treat Therapy-Related Myelodysplastic Syndrome and Acute Myelogenous Leukemia in Adults. Transplant Cell Ther. 2021 Nov;27(11):923.e1-923.e12. doi: 10.1016/j.jtct.2021.08.010. Epub 2021 Aug 21. PMID: 34428556; PMCID: PMC9064046.
    DOI
    10.1016/j.jtct.2021.08.010
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/51889
    PubMed ID
    34428556
    Rights
    Copyright © 2021. Published by Elsevier Inc.
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jtct.2021.08.010
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