TY - JOUR
T1 - Rapid Donor Identification Improves Survival in High-Risk First-Remission Patients with Acute Myeloid Leukemia
AU - Pagel, John M.
AU - Othus, Megan
AU - Garcia-Manero, Guillermo
AU - Fang, Min
AU - Radich, Jerald P.
AU - Rizzieri, David A.
AU - Marcucci, Guido
AU - Strickland, Stephen A.
AU - Litzow, Mark R.
AU - Lynn Savoie, M.
AU - Spellman, Stephen R.
AU - Confer, Dennis L.
AU - Chell, Jeffrey W.
AU - Brown, Maria
AU - Medeiros, Bruno C.
AU - Sekeres, Mikkael A.
AU - Lin, Tara L.
AU - Uy, Geoffrey L.
AU - Powell, Bayard L.
AU - Bayer, Ruthee Lu
AU - Larson, Richard A.
AU - Stone, Richard M.
AU - Claxton, David
AU - Essell, James
AU - Luger, Selina M.
AU - Mohan, Sanjay R.
AU - Moseley, Anna
AU - Erba, Harry P.
AU - Appelbaum, Frederick R.
N1 - Funding Information:
Supported by the National Cancer Institute of the National Institutes of Health under Award Nos. CA180888, CA180819, CA18020, CA180821, CA180863, CA077202, CA180816, CA180855, CA180846, CA189848, CA189957, CA180858, CA189860, CA180798, CA189953, CA189856, CA180835, CA189822, CA189971, CA189858, CA189830, CA180801, CA189853, CA189872, CA180826, CA11083, CA46282, CA46368, CA46136, CA46113, CA16385, CA12644, CA04919, CA13612, CA35119, CA73590, CA58723, and CCSRI No. 021039. The National Marrow Donor Program was supported by several grants from the Office of Naval Research (N00014-14-1-0028, N00014-15-1-0848, N00014-16-2020, and N00014-1-17-2388). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Department of the Navy, the Department of Defense, or any other agency of the US Government. We thank the patients who participated in this trial and their families, the team members from each treating institution, and the support staff from the Fred Hutchinson Cancer Research Center for help with clinical trial management.
Funding Information:
Supported by the National Cancer Institute of the National Institutes of Health under Award Nos. CA180888, CA180819, CA18020, CA180821, CA180863, CA077202, CA180816, CA180855, CA180846, CA189848, CA189957, CA180858, CA189860, CA180798, CA189953, CA189856, CA180835, CA189822, CA189971, CA189858, CA189830, CA180801, CA189853, CA189872, CA180826, CA11083, CA46282, CA46368, CA46136, CA46113, CA16385, CA12644, CA04919, CA13612, CA35119, CA73590, CA58723, and CCSRI No. 021039. The National Marrow Donor Program was supported by several grants from the Office of Naval Research (N00014-14-1-0028, N00014-15-1-0848, N00014-16-2020, and N00014-1-17-2388). The content of this article is solely the responsibility of the authors and does not necessarily represent the
Publisher Copyright:
Copyright © 2020 American Society of Clinical Oncology. All rights reserved.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - PURPOSE Patients with acute myeloid leukemia with high-risk cytogenetics in first complete remission (CR1) achieve better outcomes if they undergo allogeneic hematopoietic cell transplantation (HCT) compared with consolidation chemotherapy alone. However, only approximately 40% of such patients typically proceed to HCT. METHODS We used a prospective organized approach to rapidly identify donors to improve the allogeneic HCT rate in adults with high-risk acute myeloid leukemia in CR1. Newly diagnosed patients had cytogenetics obtained at enrollment, and those with high-risk cytogenetics underwent expedited HLA typing and were encouraged to be referred for consultation with a transplantation team with the goal of conducting an allogeneic HCT in CR1. RESULTS Of 738 eligible patients (median age, 49 years; range, 18-60 years of age), 159 (22%) had high-risk cytogenetics and 107 of these patients (67%) achieved CR1. Seventy (65%) of the high-risk patients underwent transplantation in CR1 (P, .001 compared with the historical rate of 40%). Median time to HCT from CR1 was 77 days (range, 20-356 days). In landmark analysis, overall survival (OS) among patients who underwent transplantation was significantly better compared with that of patients who did not undergo transplantation (2-year OS, 48% v 35%, respectively [P = .031]). Median relapse-free survival after transplantation in the high-risk cohort who underwent transplantation in CR1 (n = 70) was 11.5 months (range, 4-47 months), and median OS after transplantation was 14 months (range, 4-44 months). CONCLUSION Early cytogenetic testing with an organized effort to identify a suitable allogeneic HCT donor led to a CR1 transplantation rate of 65% in the high-risk group, which, in turn, led to an improvement in OS when compared with the OS of patients who did not undergo transplantation.
AB - PURPOSE Patients with acute myeloid leukemia with high-risk cytogenetics in first complete remission (CR1) achieve better outcomes if they undergo allogeneic hematopoietic cell transplantation (HCT) compared with consolidation chemotherapy alone. However, only approximately 40% of such patients typically proceed to HCT. METHODS We used a prospective organized approach to rapidly identify donors to improve the allogeneic HCT rate in adults with high-risk acute myeloid leukemia in CR1. Newly diagnosed patients had cytogenetics obtained at enrollment, and those with high-risk cytogenetics underwent expedited HLA typing and were encouraged to be referred for consultation with a transplantation team with the goal of conducting an allogeneic HCT in CR1. RESULTS Of 738 eligible patients (median age, 49 years; range, 18-60 years of age), 159 (22%) had high-risk cytogenetics and 107 of these patients (67%) achieved CR1. Seventy (65%) of the high-risk patients underwent transplantation in CR1 (P, .001 compared with the historical rate of 40%). Median time to HCT from CR1 was 77 days (range, 20-356 days). In landmark analysis, overall survival (OS) among patients who underwent transplantation was significantly better compared with that of patients who did not undergo transplantation (2-year OS, 48% v 35%, respectively [P = .031]). Median relapse-free survival after transplantation in the high-risk cohort who underwent transplantation in CR1 (n = 70) was 11.5 months (range, 4-47 months), and median OS after transplantation was 14 months (range, 4-44 months). CONCLUSION Early cytogenetic testing with an organized effort to identify a suitable allogeneic HCT donor led to a CR1 transplantation rate of 65% in the high-risk group, which, in turn, led to an improvement in OS when compared with the OS of patients who did not undergo transplantation.
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U2 - 10.1200/JOP.19.00133
DO - 10.1200/JOP.19.00133
M3 - Article
C2 - 32048933
AN - SCOPUS:85086354395
SN - 2688-1527
VL - 16
SP - E464-E475
JO - JCO Oncology Practice
JF - JCO Oncology Practice
IS - 6
ER -