TY - JOUR
T1 - Hematopoietic stem cell transplantation for adult patients with isolated NPM1 mutated acute myeloid leukemia in first remission
AU - Poire, Xavier
AU - Labopin, Myriam
AU - Polge, Emmanuelle
AU - Blaise, Didier
AU - Chevallier, Patrice
AU - Maertens, Johan
AU - Deconinck, Eric
AU - Forcade, Edouard
AU - Rambaldi, Alessandro
AU - Baerlocher, Gabriela M.
AU - Zuckerman, Tsila
AU - Volin, Liisa
AU - Schouten, Harry C.
AU - Ifrah, Norbert
AU - Mohty, Mohamad
AU - Esteve, Jordi
AU - Nagler, Arnon
N1 - Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2019/2
Y1 - 2019/2
N2 - Acute myeloid leukemia (AML) in first remission (CR1) with isolated NPM1 mutation (iNPM1m) is considered a good prognosis genotype, although up to one-third relapse. To evaluate the best transplant strategy, we retrospectively compared autologous stem cell transplantation (auto-SCT), related (MSD), and fully matched unrelated (MUD) allogeneic stem cell transplantation (allo-SCT). We identified 256 adult patients including 125 auto-SCT, 72 MSD, and 59 MUD. The 2-year leukemia-free survival (LFS) was 62% in auto-SCT, 69% in MUD, and 81% in MSD (P = .02 for MSD vs others). The 2-year overall survival (OS) was not different among auto-SCT, MUD, and MSD, reaching 83% (P = .88). The 2-year non-relapse mortality (NRM) was 2.5% in auto-SCT and 7.5% in allo-SCT (P = .04). The 2-year cumulative incidence of relapse (RI) was higher after auto-SCT (30%) than after MUD (22%) and MSD (12%, P = .01). In multivariate analysis, MSD versus auto-SCT but not MUD versus auto-SCT was associated with lower RI (P <.01 and P = .13, respectively) and better LFS (P = .01 and P = .31, respectively). Age correlated with higher NRM (P <.01). Allo-SCT using MSD appears as a reasonable transplant option for young patients with iNPM1m AML in CR1. Auto-SCT was followed by worse RI and LFS, but similar OS to both allo-SCT modalities.
AB - Acute myeloid leukemia (AML) in first remission (CR1) with isolated NPM1 mutation (iNPM1m) is considered a good prognosis genotype, although up to one-third relapse. To evaluate the best transplant strategy, we retrospectively compared autologous stem cell transplantation (auto-SCT), related (MSD), and fully matched unrelated (MUD) allogeneic stem cell transplantation (allo-SCT). We identified 256 adult patients including 125 auto-SCT, 72 MSD, and 59 MUD. The 2-year leukemia-free survival (LFS) was 62% in auto-SCT, 69% in MUD, and 81% in MSD (P = .02 for MSD vs others). The 2-year overall survival (OS) was not different among auto-SCT, MUD, and MSD, reaching 83% (P = .88). The 2-year non-relapse mortality (NRM) was 2.5% in auto-SCT and 7.5% in allo-SCT (P = .04). The 2-year cumulative incidence of relapse (RI) was higher after auto-SCT (30%) than after MUD (22%) and MSD (12%, P = .01). In multivariate analysis, MSD versus auto-SCT but not MUD versus auto-SCT was associated with lower RI (P <.01 and P = .13, respectively) and better LFS (P = .01 and P = .31, respectively). Age correlated with higher NRM (P <.01). Allo-SCT using MSD appears as a reasonable transplant option for young patients with iNPM1m AML in CR1. Auto-SCT was followed by worse RI and LFS, but similar OS to both allo-SCT modalities.
KW - BONE-MARROW-TRANSPLANTATION
KW - ACUTE MYELOCYTIC-LEUKEMIA
KW - MINIMAL RESIDUAL DISEASE
KW - NO-DONOR ANALYSIS
KW - WORKING PARTY
KW - INTENSIVE CHEMOTHERAPY
KW - EUROPEAN-SOCIETY
KW - AML PATIENTS
KW - MUTATIONS
KW - BLOOD
U2 - 10.1002/ajh.25355
DO - 10.1002/ajh.25355
M3 - Article
C2 - 30456896
SN - 0361-8609
VL - 94
SP - 231
EP - 239
JO - American Journal of Hematology
JF - American Journal of Hematology
IS - 2
ER -