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X. Poiré et al.
AB
CD
Figure 3. Relapse incidence (RI), non-relapse mortality (NRM), leukemia-free survival (LFS) and overall survival (OS) by cytogenetic groups in patients in first remis- sion. The 2-year cumulative incidence of relapse increased significantly from the “none group” up to the “abn(17p) group”, reaching 48.9% [95% CI: 30.9-64.7], 43.9% [95% CI: 29.6-57.4], 58.7% [95% CI: 48.7-67.4] and 70.1% [95% CI: 60.6-77.8] in the none, CK, MK and abn(17p) groups, respectively (P=0.006) (A). The 2- year probability of NRM was similar across the four groups, reaching 19.9% [95% CI: 16.4-23.7] (P=0.87) (B). The two-year probability of LFS was 34.7% [95% CI: 18.6-50.9] for the “none group”, 33.5% [95% CI: 19.9-47] for the “CK group”, 23.9% [95% CI: 15.7-32] for the “MK group” and 13.6% [95% CI: 7-20.2] for the “abn(17p) group” (P<0.001) (C). The 2-year probability of OS decreased significantly from the “none group” down to the “abn(17p) group”, reaching 58.5% [95% CI: 42.3-74.6], 36.5% [95% CI: 22.6-50.3], 33% [95% CI: 23.9-42] and 16.1% [95% CI: 8.9-23.3] in each group, respectively (P<0.001) (D).
group”, we then performed a univariate analysis within the “MK group” comparing the outcome between patients with presence or absence of additional -7/7q- and did not find any significant impact on RI, NRM, LFS, OS and GRFS. We also looked at the impact of MK within the “abn(17p)”; MK lost its negative impact in this very high- risk subgroup, even though the group of abn(17p) patients without MK was rather small (n=26) (data not shown).
Discussion
-5/5q- is a common finding in AML, consistently asso- ciated with poor outcomes after standard chemotherapy with long-term overall survival of about 5%.5,22 SCT has
been shown to significantly improve the outcome of high-risk AML subsets, with a probability of disease cure in the range of 40%.1,8,9,23 Nonetheless, in our large cohort of 501 AML patients harboring -5/5q undergoing first SCT, the 2-year probability of OS and LFS was only 27% and 20%, respectively, outcomes which clearly appear inferior to those reported for other high-risk cytogenetic AML,8 suggesting an independent deleterious effect of - 5/5q- on transplant outcome. Indeed, in the EBMT reg- istry, we found 3,021 patients with adverse cytogenetics according to the MRC classification with the exception of -5/5q-, and we found a 2-year OS and LFS of 43% and 37%, respectively. In contrast, our results resemble those of patients with MK AML.24-26 Indeed, most of the patients in our cohort harbored additional adverse cyto-
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haematologica | 2020; 105(2)