Yoon, Jae-Ho; Kim, Hee-Je; Park, Sung-Soo; Jeon, Young-Woo; Lee, Sung-Eun; Cho, Byung-Sik; Eom, Ki-Seong; Kim, Yoo-Jin; Lee, Seok; Min, Chang-Ki; Cho, Seok-Goo; Kim, Dong-Wook; Lee, Jong-Wook; Min, Woo-Sung
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
2017Apr ; 23 ( 4 ) :588-597.
PMID : 28089879
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Yoon, Jae-Ho -
Kim, Hee-Je -
Park, Sung-Soo -
Jeon, Young-Woo -
Lee, Sung-Eun -
Cho, Byung-Sik -
Eom, Ki-Seong -
Kim, Yoo-Jin -
Lee, Seok -
Min, Chang-Ki -
Cho, Seok-Goo -
Kim, Dong-Wook -
Lee, Jong-Wook -
Min, Woo-Sung -
ABSTRACT
The role of autologous hematopoietic cell transplantation (auto-HCT) for postremission therapy of acute myeloid leukemia is yet to be elucidated. We retrospectively analyzed 240 patients treated with auto-HCT in first remission. All patients were treated with standard induction chemotherapy, and CD34(+)?stem cells were collected at each cycle of consolidation. Stem cells were infused after total body irradiation (1200 cGy), cytarabine (9 g/m(2)), and melphalan (100?mg/m(2)). Estimated 5-year overall survival, disease-free survival (DFS), cumulative incidence of relapse (CIR), and nonrelapse mortality were 58.4%, 55.3%, 38.8%, and 5.9%, respectively. We identified that poor-risk karyotype showed very poor outcome after auto-HCT, and then analyzed 85 patients with good to intermediate-risk molecular cytogenetics with available molecular study results and markers for minimal residual disease (MRD) such as WT1 and core-binding factor (CBF) associated MRD (ie, AML1/ETO and CBFβ/MYH11). Our data identified that old age, pre-HCT markers for MRD, and high post-HCT WT1, high dose of CD34(+)?stem cell (??.5 × 10(6)/kg) infusion, and c-kit or FLT3-ITD mutations were associated with higher relapse rate and poor DFS. Using pre-HCT parameters, except for post-HCT WT1, multivariate analysis revealed that patients with young age (<40 years old), no adverse mutations, and limited dose of CD34(+)?stem cells might be good candidate for auto-HCT (3-year DFS and CIR were 83.4% and 16.6%, respectively). Young patients with good- to intermediate-risk molecular cytogenetics may benefit from auto-HCT if stem cell dose is limited. CI - Copyright ??2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
Acute myeloid leukemia; Autologous hematopoietic cell transplantation; Core-binding factor positive; FLT3 mutation; c-kit mutation
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