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Blood, 1 July 2007, Vol. 110, No. 1, pp. 409-417.
Prepublished online as a Blood First Edition Paper on March 20, 2007; DOI 10.1182/blood-2006-10-043299.


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TRANSPLANTATION

Impact of cytogenetics on outcome of matched unrelated donor hematopoietic stem cell transplantation for acute myeloid leukemia in first or second complete remission

Martin S. Tallman1, Gordon W. Dewald2, Sharavi Gandham3, Brent R. Logan4, Armand Keating5, Hillard M. Lazarus6, Mark R. Litzow2, Jayesh Mehta1, Tanya Pedersen7, Waleska S. Pérez4, Jacob M. Rowe8, Meir Wetzler9, and Daniel J. Weisdorf10

1 Northwestern University Feinberg School of Medicine, Chicago, IL; 2 Mayo Clinic and Foundation, Rochester, MN; 3 Fred Hutchinson Cancer Research Center, Seattle WA; 4 Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee; 5 Princess Margaret Hospital, Toronto, ON; 6 University Hospitals of Cleveland, OH; 7 Center for International Blood and Marrow Transplant Research, Minneapolis, MN; 8 Rambam Medical Center, Haifa, Israel; 9 Roswell Park Cancer Center Institute, Buffalo, NY; 10 University of Minnesota, Minneapolis

We compared the treatment-related mortality, relapse rate, disease-free survival (DFS), and overall survival (OS) by cytogenetic risk group of 261 patients with acute myeloid leukemia in first complete remission (CR1) and 299 patients in CR2 in undergoing matched unrelated donor hematopoietic stem cell transplantation (HSCT). For patients in first CR, the DFS and OS at 5 years were similar for the favorable, intermediate, and unfavorable risk groups at 29% (95% confidence interval [CI], 8%-56%) and 30% (22%-38%); 27% (19%-39%) and 29% (8%-56%); and 30% (95% CI, 22%-38%) and 30% (95% CI, 20%-41%), respectively. For patients in second CR, the DFS and OS at 5 years were 42% (95% CI, 33%-52%) and 35% (95% CI, 28%-43%); 38% (95% CI, 23%-54%) and 45% (95% CI, 35%-55%); and 37% (95% CI, 30%-45%) and 36% (95% CI, 21%-53%), respectively. Cytogenetics had little influence on the overall outcome for patients in first CR. In second CR, outcome was modestly, but not significantly, better for patients with favorable cytogenetics. The graft-versus-leukemia effect appeared effective, even in patients with unfavorable cytogenetics. However, treatment-related mortality was high. Matched unrelated donor HSCT should be considered for all patients with unfavorable cytogenetics who lack a suitable HLA-matched sibling donor.


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