Cytogenetics and outcome of allogeneic transplantation in first remission of acute myeloid leukemia: the French pediatric experience.
Fiche publication
Date publication
décembre 2016
Journal
Bone marrow transplantation
Auteurs
Membres identifiés du Cancéropôle Est :
Dr POCHON Cécile
Tous les auteurs :
Alloin AL, Leverger G, Dalle JH, Galambrun C, Bertrand Y, Baruchel A, Auvrignon A, Gandemer V, Ragu C, Loundou A, Bilhou-Nabera C, Lafage-Pochitaloff M, Dastugue N, Nelken B, Jubert C, Rialland F, Plat G, Pochon C, Vannier JP, Rohrlich PS, Kanold J, Lutz P, Sirvent A, Oudin C, Cuccuini W, Michel G
Lien Pubmed
Résumé
We analyzed the impact of cytogenetics on 193 children enrolled in two successive French trials (LAME89/91 and ELAM02), who received hematopoietic stem cell transplantation during CR1. Detailed karyotype was available for 66/74 (89%) in LAME89/91 and 118/119 (99%) in ELAM02. Several karyotype and transplant characteristics differed according to therapeutic protocol: unfavorable karyotypes were more frequent in ELAM02 (36% vs 18%), pretransplant chemotherapy included high-dose cytarabine in ELAM02 and not in LAME89/91, IV replaced oral busulfan in the conditioning regimen, methotrexate was removed from post-transplant immunosuppression, and matched unrelated donor and cord blood transplantation were introduced. Five-year overall survival (OS) was 78.2% in LAME89 and 81.4% in ELAM02. OS was significantly lower for the unfavorable cytogenetic risk group in LAME89/91 when compared with intermediate and favorable groups (50% vs 90.6 and 86.4%, P=0.001). This difference was no longer apparent in ELAM02 (80.9% vs 71.3% and 5/5, respectively). Survival improvement for children with unfavorable karyotype was statistically significant (P=0.026) and was due to decrease in relapse risk. Five-year transplantation-related mortality was 6.75% in LAME89/91. In ELAM02, it was 3.2% for patients with a sibling donor and 10.9% with an unrelated donor or cord blood. We conclude that the outcome of children with unfavorable karyotype transplanted in CR1 has improved.Bone Marrow Transplantation advance online publication, 12 December 2016; doi:10.1038/bmt.2016.293.
Référence
Bone Marrow Transplant.. 2016 Dec;: