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Acute Leukemias

Factors predicting outcome after unrelated donor stem cell transplantation in primary refractory acute myeloid leukaemia

Leukemia volume 25, pages 808–813 (2011)Cite this article

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Abstract

Treatment options for adults with primary refractory acute myeloid leukaemia (PREF AML) are extremely limited. Although sibling allogeneic stem cell transplantation can result in long-term survival, most patients lack a matched family donor and are destined to die of refractory disease. Greater availability of unrelated donors and improvements in supportive care have increased the proportion of patients with PREF AML in whom allografting is technically feasible, but the outcome of unrelated donor transplantation in this population has not been studied. We therefore analysed overall survival in 168 patients with PREF AML, who underwent unrelated donor transplantation between 1994 and 2006. The 5-year overall survival for the whole group was 22%. In multivariate analysis, fewer than three courses of induction chemotherapy, a lower percentage of bone marrow blasts at transplant and patient cytomegalovirus seropositivity were associated with improved survival. This allowed the development of a scoring system that identified four groups with survival rates between 44±11% and 0%. This study demonstrates an important role for unrelated donor transplantation in the management of selected patients with PREF AML and confirms the importance of initiating an urgent unrelated donor search in patients with no matched sibling donor, who fail to respond to induction chemotherapy.

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Acknowledgements

We thank the clinicians and data managers at the contributing centres: Gratwohl A, Basel; Vitek A, Prague; Einsele H, Würzburg; Russell NH, Nottingham; Arnold R, Berlin; Bosi A, Firenze; Clark RE, Liverpool; Sakellari I, Thessaloniki; Schaefer-Eckart K, Nürnberg; Nagler A, Tel-Hashomer; Schmid C, Augsburg; Apperley J, London; Potter M, London; Guilhot F, Poitiers; Pfrepper C, Leipzig; Scheid C, Cologne; Oldani E Paolo, Bergamo; Wahlin A, Umeå; Naparstek E Paolo, Tel Aviv; Socié G, Paris; Maertens J, Leuven; Ringden O, Stockholm; Gorin NCN, Paris; Blaise D, Marseille; Brown P, Dublin; Alessandrino EP, Pavia; Selleslag D, Brugge; Dreger P, Heidelberg; Krieger O, Linz; Harhalakis N, Athens; Michallet M, Lyon; Cannell P, Perth; Caballero D, Salamanca; Liakopoulou E, Manchester; Diez-Martin JL, Madrid.

Author ContributionsCC was the principal investigator, wrote the paper, recruited patients and analysed the data; ML and SP analyzed the data and helped write the paper; JF, DB, HG, GE, N-KS, AZ, RS, SB, H-JK, LV, AF, EP and CS recruited patients; VR recruited patients, analyzed data and helped write the paper. All authors approved the final manuscript.

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Authors and Affiliations

  1. Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK

    C Craddock & S Pillai

  2. EBMT ALWP Office, Faculte de Medecine St-Antoine, Paris, France

    M Labopin, E Polge, M Mohty & V Rocha

  3. Department of Medicine-Hematology, Oncology, University of Freiburg, Freiburg, Germany

    J Finke

  4. Klinik fuer Innere Medzin III, Universitätsklinikum, Ulm, Germany

    D Bunjes

  5. Klinik fuer Innere Medizin, Medizinische Universitaet, Knochenmarktransplantation, Vienna, Austria

    H Greinix

  6. Universitaetsklinikum, Medizinische Klinik und Poliklinik I, Dresden, Germany

    G Ehninger

  7. Department of Bone Marrow Transplantation, University Hospital, Essen, Germany

    N-K Steckel

  8. University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany

    A R Zander

  9. Deutsche Klinik für Diagnostik, KMT Zentrum, Wiesbaden, Germany

    R Schwerdtfeger

  10. Department of Hematology, Hannover Medical University, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany

    S Buchholz

  11. Klinikum Grosshadern, Med. Klinik III, Munich, Germany

    H-J Kolb

  12. Division of Hematology, Helsinki University Central Hospital, Helsinki, Finland

    L Volin

  13. Klinik für Knochenmarktransplantation und Hämatologie/Onkologie GmbH, Idar-Oberstein, Germany

    A Fauser

  14. II Medizinische Klinik Klinikum, Augsburg, Germany

    C Schmid

  15. Centre Hospitalier et Universitaire de Nantes, Nantes, France

    M Mohty

  16. Department of Hematology, Hopital St Louis, Paris, France

    V Rocha

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  1. C Craddock
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  2. M Labopin
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  3. S Pillai
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  4. J Finke
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  5. D Bunjes
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  6. H Greinix
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  7. G Ehninger
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  8. N-K Steckel
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  9. A R Zander
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  10. R Schwerdtfeger
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  11. S Buchholz
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  12. H-J Kolb
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  13. L Volin
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  14. A Fauser
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  15. E Polge
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  16. C Schmid
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  17. M Mohty
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  18. V Rocha
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Correspondence to C Craddock.

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Craddock, C., Labopin, M., Pillai, S. et al. Factors predicting outcome after unrelated donor stem cell transplantation in primary refractory acute myeloid leukaemia. Leukemia 25, 808–813 (2011). https://doi.org/10.1038/leu.2011.13

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  • DOI: https://doi.org/10.1038/leu.2011.13

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