Secondary Acute Myeloid Leukemia and the Role of Allogeneic Stem Cell Transplantation in a Population-Based Setting
(2019) In Biology of Blood and Marrow Transplantation 25(9). p.1770-1778- Abstract
Secondary AML (s-AML), including AML with an antecedent hematologic disorder (AHD-AML) and therapy-related AML (t-AML), constitutes a large proportion of patients with AML and is considered to confer a dismal prognosis. The role of allogeneic hematopoietic cell transplantation (HCT) in patients with s-AML and the extent to which HCT is performed in these patients has been little studied to date. We used the population-based Swedish AML Registry comprising 3337 intensively treated adult patients over a 17-year period to study the role of HCT within the group of patients with s-AML as well as compared with patients with de novo AML. HCT was performed in 576 patients (22%) with de novo AML, in 74 patients (17%) with AHD-AML, and in 57... (More)
Secondary AML (s-AML), including AML with an antecedent hematologic disorder (AHD-AML) and therapy-related AML (t-AML), constitutes a large proportion of patients with AML and is considered to confer a dismal prognosis. The role of allogeneic hematopoietic cell transplantation (HCT) in patients with s-AML and the extent to which HCT is performed in these patients has been little studied to date. We used the population-based Swedish AML Registry comprising 3337 intensively treated adult patients over a 17-year period to study the role of HCT within the group of patients with s-AML as well as compared with patients with de novo AML. HCT was performed in 576 patients (22%) with de novo AML, in 74 patients (17%) with AHD-AML, and in 57 patients (20%) with t-AML. At 5 years after diagnosis, there were no survivors among patients with previous myeloproliferative neoplasms who did not undergo HCT, and corresponding survival for patients with antecedent myelodysplastic syndromes and t-AML was and 2% and 4%, respectively. HCT was compared with chemotherapy consolidation in s-AML using 3 models: (1) a 200-day landmark analysis, in which HCT was favorable compared with conventional consolidation (P = .04, log-rank test); (2) a multivariable Cox regression with HCT as a time-dependent variable, in which the hazard ratio for mortality was 0.73 (95% confidence interval, 0.64 to 0.83) for HCT and favored HCT in all subgroups; and (3) a propensity score matching analysis, in which the 5-year overall survival (OS) and relapse-free survival in patients with s-AML in first complete remission (CR1) was 48% and 43%, respectively, for patients undergoing HCT versus 20% and 21%, respectively, for those receiving chemotherapy consolidation (P = .01 and .02, respectively, log-rank test). Our observational data suggest that HCT improves survival and offers the only realistic curative treatment option in patients with s-AML.
(Less)
- author
- organization
- publishing date
- 2019-06-06
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Allogeneic hematopoietic cell transplantation, Population-based, Secondary AML, Therapy-related AML
- in
- Biology of Blood and Marrow Transplantation
- volume
- 25
- issue
- 9
- pages
- 1770 - 1778
- publisher
- Elsevier
- external identifiers
-
- pmid:31176789
- scopus:85067980147
- ISSN
- 1083-8791
- DOI
- 10.1016/j.bbmt.2019.05.038
- language
- English
- LU publication?
- yes
- id
- 407e42e2-4bf7-4f38-a474-7f8c8e5eec69
- date added to LUP
- 2019-07-10 12:52:25
- date last changed
- 2024-03-19 17:23:13
@article{407e42e2-4bf7-4f38-a474-7f8c8e5eec69, abstract = {{<p>Secondary AML (s-AML), including AML with an antecedent hematologic disorder (AHD-AML) and therapy-related AML (t-AML), constitutes a large proportion of patients with AML and is considered to confer a dismal prognosis. The role of allogeneic hematopoietic cell transplantation (HCT) in patients with s-AML and the extent to which HCT is performed in these patients has been little studied to date. We used the population-based Swedish AML Registry comprising 3337 intensively treated adult patients over a 17-year period to study the role of HCT within the group of patients with s-AML as well as compared with patients with de novo AML. HCT was performed in 576 patients (22%) with de novo AML, in 74 patients (17%) with AHD-AML, and in 57 patients (20%) with t-AML. At 5 years after diagnosis, there were no survivors among patients with previous myeloproliferative neoplasms who did not undergo HCT, and corresponding survival for patients with antecedent myelodysplastic syndromes and t-AML was and 2% and 4%, respectively. HCT was compared with chemotherapy consolidation in s-AML using 3 models: (1) a 200-day landmark analysis, in which HCT was favorable compared with conventional consolidation (P = .04, log-rank test); (2) a multivariable Cox regression with HCT as a time-dependent variable, in which the hazard ratio for mortality was 0.73 (95% confidence interval, 0.64 to 0.83) for HCT and favored HCT in all subgroups; and (3) a propensity score matching analysis, in which the 5-year overall survival (OS) and relapse-free survival in patients with s-AML in first complete remission (CR1) was 48% and 43%, respectively, for patients undergoing HCT versus 20% and 21%, respectively, for those receiving chemotherapy consolidation (P = .01 and .02, respectively, log-rank test). Our observational data suggest that HCT improves survival and offers the only realistic curative treatment option in patients with s-AML.</p>}}, author = {{Nilsson, Christer and Hulegårdh, Erik and Garelius, Hege and Möllgård, Lars and Brune, Mats and Wahlin, Anders and Lenhoff, Stig and Frödin, Ulla and Remberger, Mats and Höglund, Martin and Juliusson, Gunnar and Stockelberg, Dick and Lehmann, Sören}}, issn = {{1083-8791}}, keywords = {{Allogeneic hematopoietic cell transplantation; Population-based; Secondary AML; Therapy-related AML}}, language = {{eng}}, month = {{06}}, number = {{9}}, pages = {{1770--1778}}, publisher = {{Elsevier}}, series = {{Biology of Blood and Marrow Transplantation}}, title = {{Secondary Acute Myeloid Leukemia and the Role of Allogeneic Stem Cell Transplantation in a Population-Based Setting}}, url = {{http://dx.doi.org/10.1016/j.bbmt.2019.05.038}}, doi = {{10.1016/j.bbmt.2019.05.038}}, volume = {{25}}, year = {{2019}}, }