Allogeneic stem cell transplantation can improve outcome of AML patients without complete cytogenetic response after induction and consolidation treatment
Abstract:
Our retrospective analysis was performed on 376 consecutive patients diagnosed with AML. A total of 256 (68%) were treated with standard “7+3” induction and high-dose cytarabine and mitoxantrone containing “4+3” consolidation/intensification regimens. Our study focused on patients with presumably very poor prognosis – patients, who did not achieve complete cytogenetic remission (CRc). Twenty-five AML patients without CRc were further analysed for clinical and laboratory parameters. Firstly, the subgroups with or without morphologic CR were compared. Similar cytogenetic abnormalities were observed in both with myelodysplasia related changes being the most common. Complex karyotype with deletion of 5q constituted approximately a third of all karyotypes in both subgroups. There were 1 patient with intermediate risk cytogenetics in the subgroup without morphologic CR and 5 patients in the subgroup with morphologic CR. Interestingly, in 4/25 patients subclones were diminished by the chemotherapy treatment, however cytogenetically less advanced clones proliferated. Secondly, transplanted or nontransplanted patients were analysed. Allogeneic stem cell transplantation (allo-SCT) was found to be the only curative treatment for patients without CRc after 7+3 and 4+3 regimens. In our cohort, 40% of the patients, who underwent allo-SCT, are alive. Importantly, 67% of the patients, who died after allo-SCT, died of causes unrelated to progression of AML. Nonrelapse mortality is therefore one of the fields where survival could be further improved.