162 Long-Term Outcomes of 133 Patients with Intermediate-Risk Acute Myeloid Leukemia Treated with High-Dose Chemotherapy and Autologous Stem Cell Rescue in First Complete Remission

Track: Poster Abstracts
Wednesday, February 11, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Gabriel N. Mannis, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Thomas G. Martin, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Lloyd E Damon, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Aaron C. Logan , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Weiyun Ai, MD, PhD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Karin ML Gaensler, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Lawrence D Kaplan, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Anuj Mahindra, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Rebecca L. Olin, MD, MSCE , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Peter Sayre, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Catherine C Smith, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Jeffrey L. Wolf, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Jimmy Hwang, PhD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Charalambos Andreadis, MD, MSCE , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Presentation recording not available for download or distribution as requested by the presenting author.
Background:

In 2014, high-dose chemotherapy with autologous stem cell rescue (autoSCT) was removed from the NCCN guidelines as a recommended treatment for patients <60 years old with intermediate-risk (int-risk) AML in first complete remission (CR1). We comprehensively reviewed the long-term outcomes of all patients with int-risk AML treated with autoSCT in CR1 at our institution.

Patients and Methods:

This is a retrospective, single institution study of all patients with int-risk AML treated with autoSCT in CR1 between 1988-2013. Data were collected by chart review. Publicly available death indices were accessed to ensure accurate dates of death, with censoring of data on September 1, 2014. For all analyses, patients with <1 year follow-up were considered to have relapsed at the date of last follow-up. Statistical analyses were performed using STATA SE 9.

Results:

We identified 133 patients with int-risk AML who underwent autoSCT in CR1. Cytogenetics were diploid in 97 (73%); FLT3 mutation status was only assessed routinely after 2008 (21 patients total, 17/21 negative).

Of the 133 patients, 55% were women and 69% were Caucasian. Median age at autoSCT was 47 years (range 20-72). Mean CD34+ cell dose infused was 13 x 106/kg (range 2.6-63). Ten percent of patients were treated pre-1993 with bone marrow stem cells and PO busulfan (BU), 28% between 1993-2003 with peripheral blood stem cells (PBSCs) and PO BU, 35% between 2003-2007 with PBSCs and IV BU, and 28% post-2007 with PBSCs and targeted IV BU (all with 60mg/kg IV etoposide).

With a median follow-up of 4.3 years (range 0.1-17), median relapse-free survival (RFS) has not been reached; 52% of patients remain relapse-free.  Fourteen (10%) patients developed therapy-related MDS or AML. In multivariate analysis, relapse was predicted by non-Caucasian race (HR 2.5, p=0.001) and by treatment era post-2007 (HR 1.85, p=0.025). Median overall survival (OS) for the entire cohort is 6.6 years (range 0.1-17).

Twenty six of 54 relapsing patients (48%) subsequently received an alloSCT, with 16 (62%) proceeding to alloSCT in CR2 and 7 (27%) with active disease. Twelve (46%) patients relapsed following alloSCT. Of the 26 alloSCT patients, 9 (35%) died from treatment-related causes and 9 (35%) from AML relapse. Median follow-up for patients receiving salvage alloSCT is 3.8 years (range 0.17-7.8) with 8 (31%) patients known to be alive and in remission. Median RFS after alloSCT is 2.5 years (range 0.02-4.32).

Conclusions:

More than half of patients with int-risk AML in CR1 achieved sustained remissions using autoSCT. Of those who relapse, nearly 50% proceed to alloSCT and 31% are long-term disease-free survivors. Relapse-free survival has likely decreased in the most recent era due to changes in patient selection. AutoSCT remains a reasonable option for int-risk patients with AML in CR1, with outcomes rivaling those currently achieved with alternative donor alloSCT.

Disclosures:
Nothing To Disclose
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