Allogeneic Stem Cell Transplant Improves the Outcome of Patients with Acute Erythroleukemia: Single Center Analysis

Background:

Acute erythroid leukemia (AEL) is a rare subtype of AML with a relatively poor prognosis. Allogeneic stem cell transplant (alloSCT) improves the outcomes of AEL, however only a small number (19%) of patients are typically able to receive alloSCT (Blood 2010; 115: 1985).

Method:

We retrospectively analyzed the outcomes of patients diagnosed with AEL (May 2008-January 2014) at University of Massachusetts Medical Center with respect to alloSCT.

Results:

Fourteen patients (3 females) were identified, median age was 73.2 years (range, 27-91) at diagnosis, 5 (35.7%) were over the age of 80 years. At diagnosis median white blood cell count was 1700 cells/mcL (range, 600-11,700), hemoglobin was 9 grams/dL (range, 7.7-12.2) and platelet count was 56,000 cells/mcL (range, 11,000-166,000). Six (42.8%) patients had high risk disease based on the karyotype, 5 (35.7%) were tested for FLT3 and NPM1 mutation and all of them were negative. Two (14.2%) patients had a prior history of MDS. As initial therapy 6 (42.8%) patients received a hypomethylating agent, 5 (35.7%) received induction chemotherapy with high dose cytarabine/mitoxanthrone. Six (42.8%) patients underwent alloSCT after receiving a reduced intensity conditioning regimen. All of them were in complete remission prior to transplant. Median time to transplant was 4.9 months (range, 2.6-7.3). One of the six (16.6%) patients developed acute GVHD, 3 (50%) had chronic GVHD.

The median OS was 16.7 months (range, 0-36.5) of all AEL patients. Patients who were able to undergo an alloSCT had a superior overall survival of 33 months compared to 7 months without transplant (p=0.036).

Conclusion:

Our institutional experience confirms that survival of patients with AEL can be significantly improved by allogeneic stem cell transplantation. Investigation of strategies that will enable more AEL patients to receive allogeneic SCT are warranted.