The outcome of allogeneic HSCT in older AML patients is determined by disease biology and not by the donor type: an analysis of 96 allografted AML patients ≥ 50 years from the Czech acute leukaemia clinical register (alert).
2013
Older patients with AML have poor prognosis after chemotherapy
and allo-SCT was historically limited to the young patients. In
the multicentre retrospective study we analyzed 96 consecutive
AML patients >= 50 years allografted with related (n=59) or
unrelated (n=37) donor. The 2- year OS and DFS rates were 45 %
and 42 % for the whole group. The corresponding figures for
related patients were 48% and 42% whereas for unrelated 42% and
42%, respectively (OS p=0,721, DFS p = 0,896). The cumulative
incidences of relapse (28% of all patients) and NRM mortality
(26%) were low with no significant differences among related
and unrelated cohorts. Multivariate analysis revealed the only
major independent variables associated with an inferior OS were
unfavourable cytogenetics (RR 3.36; CI 1.66-6.83; p=0.001) and
advanced disease status (RR 2.30; CI 1.21-4.37; p=0.011).
Unfavourable cytogenetics (RR 3.00; CI 1.50-5.99; p=0.002) and
advanced disease at SCT (RR 2.27; CI 1.22-4.22; p=0.009) were
also the only independent variables associated with inferior
DFS. In conclusion, our analysis indicates that outcomes of
allografted AML patients aged >= 50 years are determined by
cytogenetic risk category and disease status at transplantation
and not by the type of donor.
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