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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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Submitted October 13, 2006
Accepted March 1, 2007
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. Tallman*, Gordon W. Dewald, Sharavi Gandham, Brent R. Logan, Armand Keating, Hillard M. Lazarus, Mark R. Litzow, Jayesh Mehta, Tanya Pedersen, Waleska S. Perez, Jacob M. Rowe, Meir Wetzler, and Daniel J. Weisdorf
Dept of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
Lab of Medicine & Pathology, Mayo Clinic & Foundation, Rochester, MN, United States
Dept of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
CIBMTR, Medical College of Wisconsin, Milwaukee, WI, United States
Dept of Medicine, Princess Margaret Hospital, Toronto, Ontario, Canada
Dept of Medicine, University Hospitals of Cleveland, Cleveland, OH, United States
CIBMTR, National Marrow Donor Program, Minneapolis, MN, United States
Dept of Hematology & BMT, Rambam Medical Center, Haifa, Israel
Dept of Medicine, Roswell Park Cancer Institute, Buffalo, NY, United States
Adult BMT, University of Minnesota, Minneapolis, MN, United States
* Corresponding author; email: m-tallman{at}northwestern.edu.
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 myelogenous 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 (8 - 56)%, 30 (22 - 38)%; 27 (19 - 39)% and 29 (8 - 56)%; and 30 (22 - 38)% and 30 (20 - 41)%, respectively. For patients in second CR, the DFS and OS at 5 years was 42 (33 - 52)%, 35 (28 - 43)%; 38 (23 - 54)% and 45 (35 - 55)%; and 37 (30 - 45)% and 36 (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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