Program: Oral and Poster Abstracts
Session: 732. Clinical Allogeneic Transplantation: Results: Poster I
Methods: Using the CIBMTR database, patients aged ≥60 years with AML in CR2 who underwent HCT between 2001 and 2012 were identified. A number of patient, disease and transplant-related variables were analysed, and outcomes studied included overall survival (OS), leukemia-free survival (LFS), cumulative incidence of relapse (CIR), and non-relapse mortality (NRM).
Results: In total, 196 patients with AML in CR2 met the eligibility criteria for this study. Median follow-up of survivors was 73 (6-123) months. Median age at transplant was 64 years (range 60-78), 81 patients (41%) were female. Seventy one percent had a Karnofsky performance status ≥90%. De novo AML was diagnosed in 147 patients (75%). Concerning cytogenetics at diagnosis (SWOG/ECOG), 16 patients (8%) were favorable, 133 (68%) were intermediate and 17 (9%) were unfavorable risk, while 30 patients (15%) had missing data. Concerning duration of CR1, 48 patients (24%) demonstrated <6 months, 48 patients (24%) 6-12 months and 74 patients (38%) ≥12 months, missing data in 26(13%). Myeloablative conditioning regimens were used in 37 patients (19%). Fifty-eight patients (30%) had matched sibling donors, 99 (51%) were well-matched unrelated and 39 (20%) were partially matched unrelated. Peripheral blood stem cells were used in 171 patients (87%), 58 patients (30%) received in vivo T-cell depletion.
Univariate analysis demonstrated a 3-year OS of 42% (95% confidence intervals [CI] 35-49), LFS of 37% (95% CI 30-44), NRM of 25% (95% CI 19-32), and CIR of 38% (95% CI 31-45). Cumulative incidence of acute GvHD at 100 days was 33% (95% CI 26-40) while chronic GvHD at 3-years was 54% (95% CI 46-61).
Cytogenetics was the only independent risk factor (relative risk [RR] 1.14 (95% CI 0.59-2.19) and 2.32 (95% CI 1.05-5.14) for intermediate and unfavorable risk respectively) for survival in multivariate analysis. For CIR, cytogenetic risk was the predominant prognostic factor (RR 1.10 (95% CI 0.47-2.56) and 2.98 (95% CI 1.11-8.00) for intermediate and unfavorable risk respectively, p=0.008). A higher NRM was observed with bone marrow graft source (RR 2.75, p=0.002) and male gender (RR 2.04, p=0.02).
Conclusion: This study demonstrates the potential of long-term remissions with HCT in selected older patients with AML in CR2. Patients with adverse risk cytogenetics had very poor outcome due to higher risk of post-transplant relapse, and novel strategies are required for these patients.
Disclosures: Gupta: Novartis: Consultancy , Membership on an entity’s Board of Directors or advisory committees ; Incyte: Honoraria , Research Funding .
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