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High rate of durable remissions post autologous stem cell transplantation for core-binding factor acute myeloid leukaemia in second complete remission

Bone Marrow Transplantation volume 55, pages 2207–2210 (2020)Cite this article

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The presence of inversion 16 [Inv(16)] or translocation t(8;21) defines core-binding factor acute myeloid leukaemia (CBF AML) and occurs in 8% and 7% of adult AML, respectively, diminishing in frequency with increasing age [1]. CBF AML is recognised as a unique entity [2] associated with favourable risk, with 90% of patients achieving complete remission (CR1) following anthracycline and cytarabine-based induction chemotherapy [3,4,5]. Post-remission therapy with repeated cycles of high-dose cytarabine reduces the risk of relapse and prolongs overall survival (OS) [4, 6]. Numerous studies have demonstrated autologous stem cell transplantation (auto-SCT) to be a reasonable form of consolidation therapy for selected patients with CBF AML in CR1, with low treatment-related mortality (TRM) and 5-year event-free survival surpassing 60% [3, 7]. However, in the absence of a prospective randomised comparison of auto-SCT with high-dose cytarabine, this approach has not hitherto been routinely undertaken.

Following high-dose chemotherapy, ~50% of patients relapse within 5 years and 60% within 10 years [3, 4, 6, 8]. C-kit mutations portend a higher risk of relapse, particularly in t(8;21) [9]. When relapse occurs, 60–85% of patients achieve second complete remission (CR2) following salvage therapy [3, 10]. Eligible patients who achieve CR2 generally undergo allogeneic transplantation (allo-SCT). The most recent allograft data in this context describe a leukaemia-free survival probability of 54%, non-relapse mortality of 23% and a relapse incidence of 23% at 5 years [11]. However, owing to co-morbidities and the unavailability of donors in the pre-haploidentical donor era, allo-SCT has not been an option for some patients. In this circumstance, auto-SCT may be considered.

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Acknowledgements

The authors would like to thank the ABMTRR for assisting in the identification of eligible patients.

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Authors and Affiliations

  1. Department of Clinical Haematology, Austin Health, Melbourne, VIC, Australia

    Matthew J. Rees & Andrew Grigg

  2. Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia

    Andrew Spencer

  3. Department of Haematology, Auckland Hospital, Auckland, New Zealand

    Peter Browett

  4. Department of Haematology, John Hunter Children’s Hospital, Newcastle, NSW, Australia

    Frank Alvaro

  5. Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia

    Duncan Purtill

  6. Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia

    Julie Crawford

  7. Department of Haematology, St Vincent’s Hospital, Sydney, NSW, Australia

    Sam Milliken

  8. Department of Haematology, Townsville Hospital, Townsville, QLD, Australia

    Hock Lai

  9. Department of Haematology, Waikato Hospital, Hamilton, New Zealand

    Humphrey Pullon

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  1. Matthew J. Rees
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Rees, M.J., Spencer, A., Browett, P. et al. High rate of durable remissions post autologous stem cell transplantation for core-binding factor acute myeloid leukaemia in second complete remission. Bone Marrow Transplant 55, 2207–2210 (2020). https://doi.org/10.1038/s41409-020-0924-3

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