scholarly journals Burden of invasive mold disease in patients with acute myelogenous leukemia and in stem cell transplant recipients

2017 ◽  
Vol 50 (2) ◽  
pp. 261-262 ◽  
Author(s):  
Xin-Yi Yang ◽  
Wei-Ting Chen
Keyword(s):  
Stem Cell ◽  
Acute Myelogenous Leukemia ◽  
Stem Cell Transplant ◽  
Myelogenous Leukemia ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Acute Myelogenous

Outcome of First Salvage Therapy in Core Binding Factor Associated Acute Myelogenous Leukemia Is Less Than Optimal

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2952-2952
Author(s):  
Carmen Fava ◽  
Deborah Blamble ◽  
Susan O’Brien ◽  
Guillermo Garcia-Manero ◽  
Sherry Pierce ◽  
...  
Keyword(s):  
Stem Cell ◽  
Salvage Therapy ◽  
Acute Myelogenous Leukemia ◽  
Stem Cell Transplant ◽  
Myelogenous Leukemia ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Core Binding Factor ◽  
Binding Factor ◽  
Acute Myelogenous

Abstract Background: Core binding factor (CBF) associated acute myelogenous leukemia (AML) is considered to have a better prognosis compared to that of other patients with AML. Reinduction with cytarabine based therapy followed by allogeneic stem cell transplant is a standard salvage approach. Method: We performed a retrospective analysis of outcome in patients with CBF AML. Results: Between the years 1992 and 2005, 107 patients with CBF AML were treated at M.D. Anderson Cancer Center. Sixty-six (62%) patients had inv 16 abnormality and 41 (38%) had t(8;21) abnormality. Induction chemotherapy regimens included fludarabine and cytarabine with or without granulocyte colony stimulating factor (G-CSF) (66 patients) or idarubicin and cytarabine with/without G-CSF (41 patients). One hundred and one (94%) patients achieved complete remission (CR). After a median CR duration of 159 weeks, 37 (37%) patients relapsed. Relapse rate was 26/66 (39%) among patients with inv 16 abnormality and 11/41 (27%) among those with t (8;21) abnormality. Higher WBC count predicted for relapse (p=.001) and relapse rate did not differ among induction regimens (p=0.1). Salvage chemotherapy included cytarabine based regimen in 22 (59%) patients, clofarabine and idarubicin (2 patients), topoisomerase inhibitor (5 patients), histone deacetylase inhibitor (2 patients) and miscellaneous regimens (6 patients). Sixteen (43%) of the patients with relapsed CBF AML achieved CR after first salvage therapy. Eleven of 26 (42%) patients with inv 16 and 7/11 (64%) of patients with t (8;21) were resistant to first salvage therapy. Thirteen patients (10 in CR) underwent allogeneic stem cell transplant and 12 of them remained in CR post-transplant. Overall survival was significantly worse among patients who relapsed compared to the ones who did not (p=.001). Conclusion: A significant proportion of patients with CBF AML relapse and second remissions can be achieved in less than half the patients. This highlights the need for better induction/consolidation regimens in this group of patients with ‘good-risk’ AML.

Stem Cell Transplant Versus Chemotherapy in Older Adults with Acute Myelogenous Leukemia In First Remission

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2146-2146
Author(s):  
Ellin Berman ◽  
Molly Maloy ◽  
Sean M. Devlin ◽  
Esperanza B Papadopoulos ◽  
Ann A. Jakubowski
Keyword(s):  
Older Adults ◽  
Overall Survival ◽  
Stem Cell ◽  
Cord Blood ◽  
Induction Chemotherapy ◽  
Acute Myelogenous Leukemia ◽  
Stem Cell Transplant ◽  
Myelogenous Leukemia ◽  
Cell Transplant ◽  
Acute Myelogenous

Abstract Introduction Optimal therapy for older adults with acute myelogenous leukemia (AML) who achieve remission following induction chemotherapy has not been determined. Options include consolidation chemotherapy (CC) or stem cell transplant (SCT) if an appropriate donor is identified. In order to determine whether SCT improved overall survival (OS) or whether associated toxicity was increased, we performed a retrospective study comparing SCT with CC in this older age group. Methods All adult patients ages 60 to 75 years with AML in 1st remission (CR1) who underwent a SCT at MSKCC between 2001 and 2013 were reviewed and compared to age-matched patients with AML who achieved CR1 and received CC. A landmark analysis at 3 months following CR1 was used to compare OS for the 2 patient groups. Only SCT patients transplanted by landmark time were included in the analysis. Overall survival was compared using Kaplan-Meier methodology. Results Sixty-eight patients were identified for the SCT group. Thirty-two patients were identified for the CC group (Table). Stem cell sources included: peripheral blood (n=63), cord blood (n=4) and bone marrow (n=1). Fifty-six patients received a T cell depleted transplant (32 with ClinMACsTM and 24 with IsolexTM ) and 12 received an unmodified product. Conditioning regimens were busulfan/melphalan/ fludarabine (n=54), melphalan/fludarabine (n=4), cyclophosphamide/fludarabine/thiotepa/ TBI (n=4), fludarabine/busulfan (n=3), busulfan/melphalan (n=2) and thiotepa/fludarabine/TBI (n=1). Donors included matched unrelated (n=28), matched related (n=25), mismatched unrelated (n=11) and mismatched cord blood (n=4). For patients in the CC group, induction chemotherapy included cytarabine in combination with either idarubicin (n=21), daunorubicin (n=10), or mitoxantrone plus etoposide (n=1). Forty-four patients received their transplant by the 3 month landmark and 30 patients in the CC group were alive at the landmark and were included in the OS analysis. Deaths in the SCT group included 4 patients from infection, 1 from treatment-related toxicity, and 1 from relapsed disease. The estimated OS at 2 years in the landmark groups were 64% in the SCT group and 42% in the CC group (p=0.04). Conclusions Recognizing the inherent bias when retrospective studies compare SCT and CC, these data support the use of SCT for older patients with AML in CR1 who have an appropriate donor. Despite the older age, there was a statistically significant better OS with low 100 day mortality for those patients who underwent SCT. Disclosures: No relevant conflicts of interest to declare.

Late Relapses in Acute Myelogenous Leukemia: Analysis of Characteristics and Outcome.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 951-951
Author(s):  
Dushyant Verma ◽  
Stefan Faderl ◽  
Susan O’Brien ◽  
Sherry Pierce ◽  
Jorge Cortes ◽  
...  
Keyword(s):  
Stem Cell ◽  
Median Survival ◽  
Median Duration ◽  
Acute Myelogenous Leukemia ◽  
Stem Cell Transplant ◽  
Myelogenous Leukemia ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Acute Myelogenous ◽  
Wbc Count

Abstract The majority of patients with acute myelogenous leukemia (AML) who achieve complete remission (CR) with initial chemotherapy will eventually relapse. Most relapses occur in the first three years and rare patients relapse after being in CR for more than 5 years. We have reviewed retrospectively 2347 patients with AML treated at M D Anderson Cancer Center from January 1980 to July 2008. Of the total cohort, 1366 patients achieved CR and among these 942 patients relapsed. We identified 11 patients (1.16%) who relapsed after being in CR >5 years; these patients are the focus of this analysis. There were 4 females and 7 males. Their median age was 66 years (range 37–79), and their median presentation white blood cell (WBC) count was 2.3 x109/L (range, 1.1–92.3). The FAB classification was M2 in 5 patients, M1, M4, M5, M6 in 1 patient each, and unknown in 2 patients. Initial cytogenetics were diploid in 6, del(7q) in one, miscellaneous in 1, and unavailable in 3 patients. Initial therapy was with combination of idarubicin (Ida) and cytarabine (Ara-C) in 4 patients (1 with additional fludarabine), amsacrine based in 3, daunorubicin (Dauno) single agent in 2 and other agents in 2 patients. All patients except one achieved CR after the first induction course; one patient needed 2 cycles of induction to achieve CR. None underwent an allogeneic stem cell transplant in first CR. The median duration of CR was 81 months (range, 60–137). At the time of relapse, median WBC count was 4.4 x109/L (range 1.7–48.8). Karyotype at relapse was diploid in 2, del(5)del(7) in 1, del(6)del(7) in 1, trisomy 8 in 1, hyperdiploid in 2, add(2q) and add(6q) in 1 each and unavailable in 2 patients. The karyotype at relapse was different from the initial finding in 8 of 8 patients with available data at both time points. Treatment for relapse included Ida (or Dauno) with Ara-C in 8 patients (1 with additional fludarabine), and other agents in 3 patients. The response to treatment was CR in 4, partial remission in 2, resistant in 4 and unknown in 1. No patient underwent an allogeneic stem cell transplant in second CR. The median duration of the second CR was 2 months (range 0–37). The median survival after relapse was 6.4 months (range 1–39). Median survival from initial diagnosis of AML was 107 months (range 68–143). We conclude that late relapses in AML (>5 years after CR) are infrequent (1.16% of all relapses) and response to their subsequent therapy is poor; best responses occur with a regimen similar to the initial induction regimen. The karyotype at relapse is frequently different raising the question of a second AML versus relapse with the original clone.

Comorbidity and Outcomes for Patients Over Age 65 Years Treated with Allogeneic Stem Cell Transplantation for Acute Myelogenous Leukemia and Myelodysplastic Syndrome

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2032-2032 ◽  
Author(s):  
Henry J. Conter ◽  
Nhu-Nhu Nguyen ◽  
Gabriela Rondon ◽  
Julianne Chen ◽  
Elizabeth J Shpall ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Cumulative Incidence ◽  
Stem Cell Transplant ◽  
Myelogenous Leukemia ◽  
Cell Transplant ◽  
High Risk Patients ◽  
Risk Patients ◽  
Acute Myelogenous ◽  
Related Mortality

Abstract Abstract 2032 Background: Acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) preferentially afflict patients 65 years of age and older. Patients in this age group are likely to have underlying comorbid conditions. These comorbidities affect treatment planning decisions and clinical outcomes. Here we report comorbidity-stratified outcomes of patients older than 64 treated at MD Anderson Cancer Center from 1996 until 2011, inclusive, treated with allogeneic stem cell transplant (ASCT). Methods: 182 patients older than 64 received an ASCT for AML (n=143) or MDS (n=39). Patient charts were reviewed and comorbidity data abstracted using a standardized form. Burden of comorbidity was assessed using the Hematopoetic Stem Cell Transplant-Specific Comorbidity Index (HSCT-CI). Low-risk, intermediate-risk, and high-risk patients were categorised at 0, 1–2, and >=3 points as per the HSCT-CI. 157 patients were evaluable for pre-transplant comorbidity. Outcomes of interest were cumulative incidence of transplant-related mortality (TRM), cumulative incidence of relapse-related mortality (RRM), incidence of acute and chronic graft-versus-host disease (GVHD), and overall survival (OS). These were estimated from the date of transplantation. Results: The median age of transplanted patients was 67 (range 65–79), and 37 patients age 70 and older were treated. The majority of patients were intermediate-risk and high-risk patients (table), 9 patients had HSCT-CI scores of >=5. Median follow-up for alive patients was 12.6 months (n=63; range 0–118). Cumulative incidence of TRM was 6% at 100 days, 14% at 1 year, 23% at 2 years, and 36% at 5 years (figure). Cumulative incidence of RRM was 36% at 1 year, 42% at 2 years, and 47% at 5 years. HSCT-CI did not independently predict for either TRM or RRM (log-rank test p=0.95). The incidence of grade III and IV acute GVHD was 10% of all patients. The cumulative incidence of chronic GVHD was 25% at 1 year, 27% at 2 years, and 30% at 5 years, with no association between GVHD and HSCT-CI comorbidity. Conclusion: ASCT is a curative option for selected patients over age 64. HSCT-CI did not predict TRM or survival on this cohort of high-risk patients. Disease relapse was of greater concern than TRM, and so novel approaches to relapse prevention are needed. Disclosures: No relevant conflicts of interest to declare.

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