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Outcome of Allogeneic Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia Patients with Central Nervous System Involvement

Track: BMT Tandem "Scientific" Meeting
Sunday, March 2, 2014, 10:30 AM-12:00 PM
Texas D (Gaylord Texan)
Jun Aoki, MD , Division of Hematology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
Ken Ishiyama, MD, PhD , Department of Hematology, Tokyo Metropolitan Otsuka Hospital, Tokyo, Japan
Shuichi Taniguchi, MD, PhD , Department of Hematology, Toranomon Hospital, Tokyo, Japan
Takahiro Fukuda, MD , Department of Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
Kazuteru Ohashi , Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Hiroyasu Ogawa, MD, PhD , Hematology, Hyogo College of Medicine, Nishinomiya, Japan
Yasuo Morisima, MD, PhD , Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Aichi, Japan
Tokiko Nagamura, MD, PhD , Department of Cell Processing and Transfusion, Institute of Medical Science, University of Tokyo, Tokyo, Japan
Yoshiko Atsuta, MD, PhD , Department of HSCT, Data Management / Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
Hisashi Sakamaki, MD, PhD , Division of Hematology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
Akiyoshi Tkami, MD, PhD , Department of Hematology and Oncology, Kanazawa University Hospital, Ishikawa, Japan
Audio File Recorded Presentation
Introduction

Central nervous system (CNS) involvement in adult acute myeloid leukemia (AML) occurs in 2-4% of patients at diagnosis, and is considered to have a poor prognosis. Therefore, CNS involvement in AML is an indicator for allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the impact of CNS involvement in AML on the outcome of allo-HSCT remains unclear.  We performed a large-scale nationwide retrospective analysis to elucidate the outcomes of allo-HSCT for AML with CNS involvement.

Methods

Clinical data were collected from a registry database of the Japan Society for Hematopoietic Cell Transplantation. AML patients with CNS involvement aged 16 years or older who underwent the first allo-HSCT between January 2006 and December 2011 were compared to the AML patients without CNS involvement who underwent the first allo-HSCT in the same period. CNS diseases of these patients were diagnosed at any time from onset to allo-HSCT. The clinical factors affecting overall survival (OS) of AML patients with CNS involvement were analyzed using log-rank test and Cox proportional hazard model.

Result

There were 157 and 4911 AML patients with and without CNS involvement, respectively. Clinical characteristics of AML patients with and without CNS involvement are as follows median age 45 (17-68) vs. 50 (16-82) (p=0.0004), Disease status(standard/high risk):63(40%)/94(60%) vs. 2361(48%)/2549(52%) (p=0.0044). The estimated OS, cumulative incidence (CI) of relapse and non-relapse mortality in AML with CNS involvement were comparable to those for AML without CNS involvement (5-year OS, CI of relapse and NRM of AML with and without CNS involvement was 38.5% vs. 39.9% (p=0.847), 31.8% vs. 29.8% (p=0.418) and 26.7% vs. 29.0%(p=0.278) respectively). Univariate analysis showed that age at allo-HSCT (older than 50 years), the absence of chronic graft versus host disease (cGVHD), high risk of disease status (>=3rdcomplete response (CR3)/non-CR), worse ECOG performance status (>=2) and poor cytogenetic risk category according to SWOG definition predicted worse OS in AML with CNS involvement. Multivariate analysis showed that the development of cGVHD, disease status and cytogenetic risk category are independent prognostic factors for OS.

 Conclusion

The current study showed that the outcomes of allo-HSCT for AML with CNS involvement were comparable to those of AML without CNS involvement. These results suggest that allo-HSCT may overcome the poor prognosis of AML with CNS involvement and should be an effective therapeutic option for these patients.

Disclosures:
Nothing To Disclose
See more of: Oral Abstracts - Session M - Leukemia
See more of: BMT Tandem "Scientific" Meeting
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