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Acute Myeloid Leukemia
Ferrata Storti Foundation
Haematologica 2020 Volume 105(2):414-423
Allogeneic stem cell transplantation using HLA-matched donors for acute myeloid leukemia with deletion 5q or monosomy 5: a study from the Acute Leukemia Working Party of the EBMT
Xavier Poiré,1 Myriam Labopin,2,3,4,5 Emmanuelle Polge,2,3,4,5 Edouard Forcade,6 Arnold Ganser,7 Liisa Volin,8 Mauricette Michallet,9 Didier Blaise,10 Ibrahim Yakoub-Agha,11 Johan Maertens,12 Carlos Richard Espiga,13 Jan Cornelissen,14 Jürgen Finke,15 Mohamad Mohty,2,3,4,5* Jordi Esteve16* and Arnon Nagler2,3,17*
1Section of Hematology, Cliniques Universitaires St-Luc, Brussels, Belgium; 2Acute Leukemia Working Party of the EBMT; 3Sorbonne Université, Paris, France; 4INSERM UMR 938, Paris, France; 5Service d’Hématologie, Hôpital Saint-Antoine, Paris, France; 6CHU Bordeaux, Hôpital Haut-Leveque, Pessac, France; 7Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany; 8HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland; 9Service d’Hématologie, Centre Hospitalier Lyon Sud, Lyon, France; 10Institut Paoli Calmette, Programme de Transplantation Thérapie Cellulaire, Marseille, France; 11CHU de Lille, LIRIC INSERM U995, Université Lille2, Lille, France; 12University Hospital Gasthuisberg, Leuven, Belgium; 13Servicio de Hematologica-Hemoterapia, Hospital U. Marquès de Valdecilla, Santander, Spain; 14Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; 15Department of Medicine- Hematology-Oncology, University of Freiburg, Freiburg, Germany; 16Hematology Department, Hospital Clinic, Barcelona, Spain and 17Chaim Sheba Medical Center, Tel-Hashomer, Israel.
*MM, JE and AN contributed equally to this work.
ABSTRACT
Deletion 5q or monosomy 5 (-5/5q-) in acute myeloid leukemia (AML) is a common high-risk feature that is referred to allogeneic stem cell transplantation. However, -5/5q- is frequently associated with other high-risk cytogenetic aberrations such as complex karyotype, monosomal karyotype, monosomy 7 (-7), or 17p abnormalities (abn (17p)), the significance of which is unknown. In order to address this question, we studied adult patients with AML harboring -5/5q- having their first allo- geneic transplantation between 2000 and 2015. Five hundred and one patients with -5/5q- have been analyzed. Three hundred and thirty-eight patients (67%) were in first remission and 142 (28%) had an active disease at time of allogeneic transplantation. The 2-year probabilities of overall sur- vival and leukemia-free survival were 27% and 20%, respectively. The 2- year probability of treatment-related mortality was 20%. We identified four different cytogenetic groups according to additional abnormalities with prognostic impact: -5/5q- without complex karyotype, monosomal karyotype or abn(17p), -5/5q- within a complex karyotype, -5/5q- within a monosomal karyotype and the combination of -5/5q- with abn(17p). In multivariate analysis, factors associated with worse overall survival and leukemia-free survival across the four groups were active disease, age, monosomal karyotype, and abn(17p). The presence of -5/5q- without monosomal karyotype or abn(17p) was associated with a significantly bet- ter survival rate while -5/5q- in conjunction with monosomal karyotype or abn(17p) translated into a worse outcome. The patients harboring the com- bination of -5/5q- with abn(17p) showed very limited benefit from allo- geneic transplantation.
Correspondence:
XAVIER POIRÉ
xavier.poire@uclouvain.be
Received: January 7, 2019. Accepted: April 24, 2019. Pre-published: May 2, 2019.
doi:10.3324/haematol.2019.216168
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/105/2/414
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