Allogeneic Hematopoietic Cell Transplantation for Adult Chronic Myelomonocytic Leukemia.

Abstract

Allogeneic hematopoietic cell transplantation (HCT) is potentially curative for patients with chronic myelomonocytic leukemia (CMML); however, few data exist regarding prognostic factors and transplantation outcomes. We performed this retrospective study to identify prognostic factors for post-transplantation outcomes. The CMML-specific prognostic scoring system (CPSS) has been validated in subjects receiving nontransplantation therapy and was included in our study. From 2001 to 2012, 209 adult subjects who received HCT for CMML were reported to the Center for International Blood and Marrow Transplant Research. The median age at transplantation was 57 years (range, 23 to 74). Median follow-up was 51 months (range, 3 to 122). On multivariate analyses, CPSS scores, Karnofsky performance status (KPS), and graft source were significant predictors of survival (P = .004, P = .01, P = .01, respectively). Higher CPSS scores were not associated with disease-free survival, relapse, or transplantation-related mortality. In a restricted analysis of subjects with relapse after HCT, those with intermediate-2/high risk had a nearly 2-fold increased risk of death after relapse compared to those with low/intermediate-1 CPSS scores. Respective 1-year, 3-year, and 5-year survival rates for low/intermediate-1 risk subjects were 61% (95% confidence interval [CI], 52% to 72%), 48% (95% CI, 37% to 59%), and 44% (95% CI, 33% to 55%), and for intermediate-2/high risk subjects were 38% (95% CI, 28% to 49%), 32% (95% CI, 21% to 42%), and 19% (95% CI, 8% to 29%). We conclude that higher CPSS score at time of transplantation, lower KPS, and a bone marrow graft are associated with inferior survival after HCT. Further investigation of CMML disease-related biology may provide insights into other risk factors predictive of post-transplantation outcomes.

• Authors: Hien Duong Liu, Kwang Woo Ahn, Zhen-Huan Hu, Mehdi Hamadani, Taiga Nishihori, Baldeep Wirk, Amer Beitinjaneh, David Rizzieri, Michael R Grunwald, Mitchell Sabloff, Richard F Olsson, Ashish Bajel, Christopher Bredeson, Andrew Daly, Yoshihiro Inamoto, Navneet Majhail, Ayman Saad, Vikas Gupta, Aaron Gerds, Adriana Malone, Martin Tallman, Ran Reshef, David I Marks, Edward Copelan, Usama Gergis, Mary Lynn Savoie, Celalettin Ustun, Mark R Litzow, Jean-Yves Cahn, Tamila Kindwall-Keller, Gorgun Akpek, Bipin N Savani, Mahmoud Aljurf, Jacob M Rowe, Peter H Wiernik, Jack W Hsu, Jorge Cortes, Matt Kalaycio, Richard Maziarz, Ronald Sobecks, Uday Popat, Edwin Alyea, Wael Saber
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 23 Issue 5 Pg. 767-775 (May 2017) ISSN: 1523-6536 [Electronic] United States
• PMID: 28115276 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Bone Marrow Transplantation (mortality)
• Hematopoietic Stem Cell Transplantation (methods, mortality)
• Humans
• Leukemia, Myelomonocytic, Chronic (diagnosis, mortality, therapy)
• Middle Aged
• Prognosis
• Retrospective Studies
• Risk Factors
• Survival Rate
• Transplantation, Homologous
• Young Adult