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Allotransplants for Acute Myeloid Leukemia: No Impact of Extra-Medullary Leukemia on Outcomes

Track: BMT Tandem "Scientific" Meeting
Sunday, March 2, 2014, 10:30 AM-12:00 PM
Texas D (Gaylord Texan)
Sagun D. Goyal, MD, MSc , St. Louis University Medical Center, St. Louis, MO
Geoffrey L. Uy, MD , Bone Marrow Transplantation & Leukemia Section, Division of Oncology, Washington University School of Medicine, St. Louis, MO
Mei-Jie Zhang, PhD , Biostatistics, Medical College of Wisconsin, Milwaukee, WI
Hai-Lin Wang, MPH , CIBMTR, Medical College of Wisconsin, Milwaukee, WI
Steven M. Devine, MD , James Cancer Center, Ohio State Medical Center, Columbus, OH
Marcos J. G. de Lima, MD , University Hospital Case Medical Center, Cleveland, OH
Donald W. Bunjes, MD , Ulm University Hospital, Ulm, Germany
Daniel J. Weisdorf, MD , University of Minnesota, Minneapolis, MN
Audio File Recorded Presentation

 

Introduction: Extra-medullary (EM) leukemia is present in 3 – 8% of persons with AML.  Although controversial, retrospective analyses have suggested an adverse impact on outcomes of conventional therapy. Although use of allotransplants might overcome this adverse prognostic impact, data supporting this approach are limited.  Isolated EM relapses occur after allotransplants and may reflect lack of graft vs leukemia effect in EM sites.  Also, the use of reduced-intensity conditioning (RIC) regimens, T-cell-depleted grafts and non-radiation-based conditioning regimens may be associated with higher rates of EM relapse and similarly may reduce the effectiveness of allotransplants in persons with AML and EM leukemia. 

 

Methods: Retrospective analysis of variables associated with outcome of allotransplants for persons with AML with or without EM leukemia pretransplant was performed. The study population included subjects age 18-70 receiving HLA-identical sibling or HLA-matched unrelated donor transplants of bone marrow or cells from 1995-2010 reported to the CIBMTR.

Results: 9797 subjects met the selection criteria, 814 (8%) of whom had extra-medullary leukemia at different times pretransplant.  Median follow-up of survivors was 58 mo (range, 3-191 mo) for subjects with EM leukemia and 60 mo (range, 3-194 mo) for patients without EM leukemia.  Univariate analysis of outcomes showed no difference in  leukemia-free survival (LFS) or survival of subjects with or without EM leukemia pretransplant. 5 y LFSs were 33% (95% CI, 30-37%) vs 33% (95% CI, 32 v 34%; p=0.71).  5 y survivals were 36% (95% CI, 32-39%) vs 35 (95% CI, 34-37%; p=0.96; Figure 1).  In a univariate analysis, 5 y survival did not differ by site of EM leukemia (CNS, skin only, lymph node only, other vs no EM leukemia; p=0.28) or by time EM leukemia occurred (at diagnosis, vs at transplant; p=0.27).  There was no significant difference in the rate of relapse in persons with or without EM leukemia based on intensity of pretransplant conditioning.  After myelo-ablative conditioning the relative risk of relapse was 1.09 (95% CI, 0.95-1.24; p=0.21) and for RIC was 0.89 (95% CI, 0.70–1.14; p=0.36). 

Conclusions:  We found no impact of pretransplant EM leukemia on LFS or survival after allotransplant for AML.  These data suggest decisions regarding transplants should be independent of whether or not there is EM leukemia. 

Figure 1.  Probability of OS and DFS based on presence of EM disease

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