Early allogeneic transplantation favorably influences the outcome of adult patients suffering from acute myeloid leukemia View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

1997-05-01

AUTHORS

E Jourdan, D Maraninchi, J Reiffers, E Gluckman, B Rio, JP Jouet, M Michallet, L Molina, E Archimbaud, JL Harousseau, N Ifrah, M Attal, F Guilhot, M Kuentz, D Guyotat, JL Pico, C Dauriac, M Legros, F Dreyfus, P Bordigoni, V Leblond, N Gratecos, B Varet, C Auzanneau, H Tilly, E Vilmer, VJ Bardou, D Blaise

ABSTRACT

Allogeneic BMT for patients with acute myeloid leukemia (AML) is presently a reference therapy. The indications for this therapy mainly rely upon prognostic factors, and their importance is constantly reassessed. To examine the impact of time from diagnosis to transplant on survival and leukemia-free survival (LFS), we analyzed 109 patients from the database of the SFGM comprising patients who had all received an HLA-identical allogeneic BMT for a diagnosis of AML in first complete remission (CR1) between January 1987 and December 1992. All patients were conditioned with cyclophosphamide (CY) and total body irradiation (TBI) (CY-TBI), and methotrexate (MTX) + cyclosporin A (CsA) were used as graft-versus-host disease (GVHD) prophylaxis. Patient characteristics were: age = 33 ± 9, M/F = 64/45, white blood cell count (WBC) at diagnosis = 27 ± 42 × 109/l, FAB distribution: M1 and M2 = 55; M3 = 15, M4 and M5 = 33, M0, M6 and M7 = 6. Karyotyping was carried out for 64 patients: 32 had a normal karyotype, 16 had good prognosis abnormalities (t(8;21), t(15;17), inv 16) and 16 patients had other abnormalities. Eleven patients needed two courses of induction to achieve CR. Time between diagnosis and BMT was 120 (64–287) days. Forty-nine patients developed grade ⩾2 acute GVHD (actuarial probability = 46%). With a median follow-up of 50 months (27–100), the 5-year probabilities for transplant-related mortality (TRM), relapse, overall survival and LFS are respectively 25%, 26%, 59% and 55%. A multivariate analysis showed that survival is adversely influenced by three independent factors: time to transplant (>120 days vs ⩽120 days), acute GVHD (grade 2–4 vs grade 0–1) and age (>33 vs ⩽33). LFS is only influenced by the first two of these factors. The favorable impact of a shorter time from diagnosis to transplant should lead to performing the transplant as early as possible. Practically speaking, this means that when such therapy is chosen for a patient with CR1 AML, the search for an allogeneic donor should begin immediately and transplant be performed as soon as possible. More... »

PAGES

875-881

Identifiers

URI

http://scigraph.springernature.com/pub.10.1038/sj.bmt.1700761

DOI

http://dx.doi.org/10.1038/sj.bmt.1700761

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1044210116

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/9156260


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392 BMT Units:, Nantes, France
393 BMT Units:, Nice, France
394 BMT Units:, Poitiers, France
395 BMT Units:, Rennes, France
396 BMT Units:, Rouen, France
397 BMT Units:, Saint-Etienne, France
398 BMT Units:, Toulouse, France
399 rdf:type schema:Organization
400 grid-institutes:grid.14925.3b schema:alternateName Institut Gustave Roussy, Villejuif, France
401 schema:name Institut Gustave Roussy, Villejuif, France
402 rdf:type schema:Organization
403 grid-institutes:grid.411394.a schema:alternateName Hôtel-Dieu, Paris, France
404 schema:name Hôtel-Dieu, Paris, France
405 rdf:type schema:Organization
406 grid-institutes:grid.411439.a schema:alternateName Hôpital Pitié-Salpétrière, Paris, France
407 schema:name Hôpital Pitié-Salpétrière, Paris, France
408 rdf:type schema:Organization
409 grid-institutes:grid.411784.f schema:alternateName Hôpital Cochin, Paris, France
410 schema:name Hôpital Cochin, Paris, France
411 rdf:type schema:Organization
412 grid-institutes:grid.412116.1 schema:alternateName Hôpital Henri Mondor, Créteil, France
413 schema:name Hôpital Henri Mondor, Créteil, France
414 rdf:type schema:Organization
415 grid-institutes:grid.412134.1 schema:alternateName Hôpital Necker adultes, Paris, France
416 schema:name Hôpital Necker adultes, Paris, France
417 rdf:type schema:Organization
418 grid-institutes:grid.413235.2 schema:alternateName Hôpital Robert Debré, Paris, France
419 schema:name Hôpital Robert Debré, Paris, France
420 rdf:type schema:Organization
421 grid-institutes:grid.413328.f schema:alternateName Hôpital Saint-Louis, Paris, France
422 schema:name Hôpital Saint-Louis, Paris, France
423 rdf:type schema:Organization
424 grid-institutes:grid.414014.4 schema:alternateName Hôpital Val-de-Grace, Paris, France
425 schema:name Hôpital Val-de-Grace, Paris, France
426 rdf:type schema:Organization
427 grid-institutes:grid.418443.e schema:alternateName Biostatistical Unit of Institut Paoli Calmettes, Marseille, France
428 schema:name Biostatistical Unit of Institut Paoli Calmettes, Marseille, France
429 rdf:type schema:Organization
 




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