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Allografting

Evaluation of allogeneic hematopoietic SCT in younger adults with adverse karyotype AML

Bone Marrow Transplantation volume 47, pages 1436–1441 (2012)Cite this article

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Abstract

To illustrate methodological issues, we compared donor vs no-donor to transplant vs no-transplant comparisons in a cohort of 107 patients aged ⩽50 years with adverse karyotype AML in first CR. Adverse karyotypes were defined as −7, del(7q), −5, del(5q), t(9;22), 11q23, 3q26 or complex abnormalities. Mantel–Byar estimations and hematopoietic SCT (HSCT) as a time-dependent variable were used to compare transplant vs no-transplant cumulative incidence of relapse (CIR), relapse-free survival (RFS) and OS. In all, 52 patients had a sibling donor, but only 35 of them were transplanted in first CR, whereas 9 patients received HSCT from alternative stem cell sources. Donor-based analysis showed lower CIR in the donor group, not translating in prolonged RFS or OS. Conversely, transplant-based analysis showed that HSCT in the first CR improved the three CIR (multivariate hazard ratio (HR), 0.31; P<0.001), RFS (multivariate HR, 0.57; P=0.047) and OS (multivariate HR, 0.54; P=0.03) endpoints. At 5 years, OS was estimated at 33% in transplanted vs 18% in non-transplanted patients. The positive effect of HSCT was more pronounced in patients aged ⩽35 years and/or in those transplanted in the more recent years. These results confirm that HSCT is likely the best curative option in younger patients with adverse karyotype AML.

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Acknowledgements

We are grateful to Drs RK Hills and AK Burnett from the University of Cardiff, Cardiff, UK for their help.

Author contributions: HD designed the study and did statistical analysis. MAH, CG, GS and HD wrote the manuscript. SC was PI of the ALFA-9000 study. XT was PI of the ALFA-9802 study. XT, SC, ER, CP, CG, JHB, OR, TdeR, PF, MM, GS and HD enrolled patients in the study. CT and CP centrally performed and/or reviewed biological analysis. All authors approved the final manuscript.

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Authors and Affiliations

  1. Department of Haematology, Hôpital Saint-Louis, Assistance Publique—Hôpitaux de Paris (AP-HP), University Paris 7, Paris, France

    M A Hospital, E Raffoux, G Socié & H Dombret

  2. Department of Haematology, Hôpital Edouard Herriot, University Lyon 2, Lyon, France

    X Thomas & M Michallet

  3. Department of Haematology, Hôpital Mignot, University Versailles—Saint Quentin, Le Chesnay, France

    S Castaigne

  4. Department of Haematology, Hôpital Henri Mondor, AP-HP, University Paris 12, Créteil, France

    C Pautas

  5. Department of Haematology, Hôpital Avicenne, AP-HP, University Paris 13, Bobigny, France

    C Gardin & P Fenaux

  6. Institut Gustave Roussy, University Paris 11, Villejuif, France

    J-H Bourhis

  7. Department of Haematology, Hôpital Clemenceau, University Caen, Caen, France

    O Reman

  8. Department of Haematology, Hôpital Percy, Clamart, France

    T de Revel

  9. Laboratory of Cytogenetics, Hôpital Mignot, University Versailles—Saint Quentin, Le Chesnay, France

    C Terré

  10. Center of Biology and Pathology, Hôpital Claude Huriez, University Lille, Lille, France

    C Preudhomme

Authors
  1. M A Hospital
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  2. X Thomas
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  3. S Castaigne
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  4. E Raffoux
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  5. C Pautas
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  7. J-H Bourhis
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  8. O Reman
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  9. T de Revel
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  10. C Terré
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  11. C Preudhomme
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  12. P Fenaux
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  13. M Michallet
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  14. G Socié
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  15. H Dombret
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Corresponding author

Correspondence to H Dombret.

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The authors declare no conflict of interest.

Appendix

Appendix

The following ALFA investigators participated in the study: F Treilhou, K Celli-Lebras, D Réa, A de Labarthe, MT Daniel, O Maarek, JB Micol, E Raffoux, N Boissel, JM Micléa, G Socié, H Dombret (Hôpital Saint-Louis, Paris); H Djeda, N Cambier, S Darre, S de Botton, F Lai, B Quesnel (CHU, Lille); MP Chaury, C Tisseuil, L Remenieras, N Gachard, P Turlure, D Bordessoule (CHU, Limoges); S Rigaudeau, E Henry, C Terré, AL Taksin, F Suzan, D Legrand, P Rousselot, S Castaigne (Hôpital Mignot, Versailles); J Beaune, C Pautas, C Perot, K Yakouben, S Maury, M Kuentz, C Cordonnier (Hôpital Henri Mondor, Creteil); I Dervite, P Morel, B Dupriez (Hôpital Schnaffer, Lens); N Itzhar, JM Ventelon, A Bernheim, P Arnaud, JH Bourhis (Institut Gustave Roussy, Villejuif); I Plantier, L Detourmignies (Hôpital Provo, Roubaix); I Garnier, JV Malfuson, F Desangles, T Fagot, B Souleau, G Nedellec, T de Revel (Hôpital Percy, Clamart); V Tallon, F Jardin, A Stamatoulas, N Contentin, S Lepretre, P Lenain, C Bastard, H Tilly (Centre Henri Becquerel, Rouen); B Beve, C Gardin, V Eclache, JJ Kiladjian, L Ades, MP Lemonnier, P Casassus, P Fenaux (Hôpital Beaujon, Clichy, and Hôpital Avicenne, Bobigny); S Glaisner, M Janvier, A Bourguignat, E Baumelou, F Turpin (Centre Rene Huguenin, Saint-Cloud, and Hôpital Foch, Suresnes); E Lepesant, M Macro, G Plessis, S Cheze, O Reman, M Leporrier (CHU, Caen); J Frayfer, C Soussain, C Allard (Centre Hospitalier, Meaux); B Corront, J Provencal, C Martin (Centre Hospitalier, Annecy); M Blanc, J Lespinasse (Centre Hospitalier, Chambery); M Elhamri, A Thiebaut, I Tigaud, F Nicolini, K Bilger, A Belhabri, J Troncy, X Thomas, M Michallet (Hôpital Edouard Herriot, Lyon); E Ferrant, O Casasnovas, F Mugneret, JN Bastie, D Caillot (CHU, Dijon), France.

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Hospital, M., Thomas, X., Castaigne, S. et al. Evaluation of allogeneic hematopoietic SCT in younger adults with adverse karyotype AML. Bone Marrow Transplant 47, 1436–1441 (2012). https://doi.org/10.1038/bmt.2012.49

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