Abstract
Response and long term outcome to chemotherapy treatment in patient with AML may differ significantly depending on many factors identified at the time of diagnosis. Age, cytogenetics, and history of myelodysplasia are predictors of survival in patients undergoing induction chemotherapy. AML characterized by t (6;9) (p23; q34) - DEK/CAN fusion occurs only in 1–5% of AML cases. This translocation involves recurrent breakpoints in the DEK gene on chromosome 6p23 andin the CAN gene on chromosome 9q34. It predicts a poor outcome with chemotherapy alone and BMT is usually recommended as a result. However, the curative potential of BMT for t(6; 9) AML patients is unknown. We reviewed our experience treating AML with BMT. Five patients with t (6; 9) AML and one with high-risk myelodysplastic syndrome (MDS) underwent BMT following induction chemotherapy. The prep regimen was Busulfan/Cyclophosphamide in all but one patients and standard GVHD prophylaxis was used. No patient received a T-Cell depleted graft. The median follow up of survivors was 24 months (9–38 months). Our small series provides intriguing data suggesting the potential for cure of patients with AML and t (6; 9). While our data requires confirmation in a larger series of patients, our results provide a rationale to recommend BMT to these high risk patient with AML.
Table 1: Characteristics Pt. # Dx Date Age BMT Remission tatus GVHD Relapse A/D Months (Pt. #) Patient number, (Dx) Diagnosis, (BMT) bone marrow transplant date, (GVHD) graft versus host disease, (A/D) Alive/Dead from initial diagnosis, (CR) Complete remission, Matched unrelated donor, and (MSD) Matched sibling donor 1 10/04 37 MSD 6/05 CR1 Yes No A +34 2 06/04 36 MUD 10/06 CR2 NO No A +38 3 03/06 50 MUD 7/06 CR1 NO Yes D +13 4 09/05 20 MUD 12/05 CR1 NO No A +24 5 11/06 39 MSD 2/07 CR1 Yes No A +9 6 10/06 41 MSD 2/07 Refractory No No A +10
Low-Dose Cranial Boost in High-Risk Adult Leukemia Patients Undergoing Bone Marrow Transplant
