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Secondary Acute Myeloid Leukemia and the Role of Allogeneic Stem Cell Transplantation in a Population-Based Setting
Karolinska Inst, Sweden.
Sahlgrens Univ Hosp, Sweden.
Sahlgrens Univ Hosp, Sweden.
Sahlgrens Univ Hosp, Sweden.
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2019 (English)In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 25, no 9, p. 1770-1778Article in journal (Refereed) Published
Abstract [en]

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. (C) 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC , 2019. Vol. 25, no 9, p. 1770-1778
Keywords [en]
Secondary AML; Therapy-related AML; Allogeneic hematopoietic cell transplantation; Population-based
National Category
Hematology
Identifiers
URN: urn:nbn:se:liu:diva-161413DOI: 10.1016/j.bbmt.2019.05.038ISI: 000488887800008PubMedID: 31176789OAI: oai:DiVA.org:liu-161413DiVA, id: diva2:1367044
Note

Funding Agencies|Swedish Cancer Foundation; Stockholm County CouncilStockholm County Council; Gothenburg Medical Society; Assar Gabrielsson Foundation; Swedish Research CouncilSwedish Research Council

Available from: 2019-10-31 Created: 2019-10-31 Last updated: 2019-10-31

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Frodin, Ulla
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Department of Medical and Health SciencesFaculty of Medicine and Health SciencesDepartment of Haematology
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