Outcome of patients with acute myeloid leukemia with monosomal karyotype who undergo hematopoietic cell transplantation.

Publication Type:

Journal Article

Authors:

Fang, Min; Storer, Barry E; Estey, Elihu H; Othus, Megan; Zhang, Lisa; Sandmaier, Brenda M; Appelbaum, Frederick R

Source:

Blood, Volume 118, Issue 6, p.1490-4 (2011)

Keywords:

2011, Acute Disease, Adolescent, Adult, Aged, Center-Authored Paper, Child, Child, Preschool, Clinical Research Division, Female, hematopoietic stem cell transplantation, Humans, Infant, Infant, Newborn, Karyotyping, Leukemia, Myeloid, Male, Middle Aged, Monosomy, Public Health Sciences Division, Research Trials Office Core Facility - Biostatistics Service, Retrospective Studies, September 2011, Shared Resources, Survival Analysis, Transplantation, Homologous, Treatment Outcome, Young Adult

Abstract:

Monosomal karyotype (MK), defined as ≥ 2 autosomal monosomies or a single monosomy in the presence of other structural abnormalities, was confirmed by several studies to convey an extremely poor prognosis in patients with acute myeloid leukemia (AML) with a 4-year overall survival after diagnosis of < 4%. A recent investigation by the Southwest Oncology Group found that the only MK(+) patients alive and disease free > 6 years from diagnosis received allogeneic hematopoietic cell transplantation (HCT). To expand this observation, we retrospectively analyzed 432 patients treated with HCT at the Fred Hutchinson Cancer Research Center, 14% of whom were MK(+). The 4-year overall survival of patients after HCT was 25% for MK(+) AML and 56% for MK(-) AML (adjusted hazard ratio = 2.29, P < .0001). Among the MK(+) patients, complex karyotype was associated with a significantly worse outcome than patients with noncomplex karyotype (adjusted hazard ratio = 2.70, P = .03). Thus, although the prognosis of MK(+) patients remains worse than that for MK(-) patients in the transplantation setting, HCT appears to improve the overall outcome of MK(+) patients, especially patients without a complex karyotype. However, the 28% of MK(+) patients > 60 years had only a 6% 4-year survival rate after HCT, stressing the need for new approaches in these patients.