Clinical Outcome of Autologous Hematopoietic Cell Transplantation in Adult Patients with Acute Myeloid Leukemia: Who May Benefit from Autologous Hematopoietic Cell Transplantation?
The role of autologous hematopoietic cell transplantation (auto-HCT) for postremission therapy of acute myeloid leukemia is yet to be elucidated. We retrospectively analyzed 240 patients treated with auto-HCT in first remission. All patients were treated with standard induction chemotherapy, and CD34+ stem cells were collected at each cycle of consolidation. Stem cells were infused after total body irradiation (1200 cGy), cytarabine (9 g/m2), and melphalan (100 mg/m2). Estimated 5-year overall survival, disease-free survival (DFS), cumulative incidence of relapse (CIR), and nonrelapse mortality were 58.4%, 55.3%, 38.8%, and 5.9%, respectively. We identified that poor-risk karyotype showed very poor outcome after auto-HCT, and then analyzed 85 patients with good to intermediate-risk molecular cytogenetics with available molecular study results and markers for minimal residual disease (MRD) such as WT1 and core-binding factor (CBF) associated MRD (ie, AML1/ETO and CBFβ/MYH11). Our data identified that old age, pre-HCT markers for MRD, and high post-HCT WT1, high dose of CD34+ stem cell (≥4.5 × 106/kg) infusion, and c-kit or FLT3-ITD mutations were associated with higher relapse rate and poor DFS. Using pre-HCT parameters, except for post-HCT WT1, multivariate analysis revealed that patients with young age (<40 years old), no adverse mutations, and limited dose of CD34+ stem cells might be good candidate for auto-HCT (3-year DFS and CIR were 83.4% and 16.6%, respectively). Young patients with good- to intermediate-risk molecular cytogenetics may benefit from auto-HCT if stem cell dose is limited.
['Yoon|Jae-Ho|JH|', 'Kim|Hee-Je|HJ|', 'Park|Sung-Soo|SS|', 'Jeon|Young-Woo|YW|', 'Lee|Sung-Eun|SE|', 'Cho|Byung-Sik|BS|', 'Eom|Ki-Seong|KS|', 'Kim|Yoo-Jin|YJ|', 'Lee|Seok|S|', 'Min|Chang-Ki|CK|', 'Cho|Seok-Goo|SG|', 'Kim|Dong-Wook|DW|', 'Lee|Jong-Wook|JW|', 'Min|Woo-Sung|WS|']
D000293:Adolescent D000328:Adult D000368:Aged D003582:Cytogenetics D018380:Hematopoietic Stem Cell Transplantation D006801:Humans D015470:Leukemia, Myeloid, Acute D008875:Middle Aged D012074:Remission Induction D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D016019:Survival Analysis D019172:Transplantation Conditioning D014182:Transplantation, Autologous D055815:Young Adult
Autologous hematopoietic cell transplantation Acute myeloid leukemia Core-binding factor positive FLT3 mutation c-kit mutation