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Acute Leukemia

Allogeneic hematopoietic cell transplant for AML: no impact of pre-transplant extramedullary disease on outcome

Bone Marrow Transplantation volume 50, pages 1057–1062 (2015)Cite this article

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Abstract

The impact of extramedullary disease (EMD) in AML on the outcomes of allogeneic hematopoietic cell transplantation (alloHCT) is unknown. Using data from the Center for International Blood and Marrow Transplant Research, we compared the outcomes of patients who had EMD of AML at any time before transplant, with a cohort of AML patients without EMD. We reviewed data from 9797 AML patients including 814 with EMD from 310 reporting centers and 44 different countries, who underwent alloHCT between and 1995 and 2010. The primary outcome was overall survival (OS) after alloHCT. Secondary outcomes included leukemia-free survival (LFS), relapse rate and treatment-related mortality (TRM). In a multivariate analysis, the presence of EMD did not affect either OS (hazard ratio 1.00, 95% confidence interval (CI) 0.91–1.09), LFS (0.98, 0.89–1.09), TRM (relative risk 0.92, 95% CI 0.80–1.16, P=0.23) or relapse (relative risk=1.03, 95% CI, 0.92–1.16; P=0.62). Furthermore, the outcome of patients with EMD was not influenced by the location, timing of EMD, or intensity of conditioning regimen. The presence of EMD in AML does not affect transplant outcomes and should not be viewed as an independent adverse prognostic feature.

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Acknowledgements

We acknowledge the following contributing co-authors for their contributions to this manuscript: Kirk R Schultz, Mark R Litzow, Philip L McCarthy, Mahmoud D Aljurf, Mitchell S Cairo, William A Wood, Celalettin Ustun, Thomas R Klumpp, Edwin M. Horwitz, Jyotishankar Raychaudhuri, Bruce M Camitta, Yi-Bin Chen, Peter H Wiernik, Tsiporah B Shore, Selina M Luger, Ashish Bajel, Harry C Schouten, Grace H Ku, Maxim Norkin, Faiz Anwer, Asmita Mishra, Attaphol Pawarode, Amelia Langston, Mitchell Sabloff, Ann E Woolfrey, Hans-Jochem Kolb, Edmund K Waller, Usama Gergis, John Koreth, Reinhold Munker, Joseph McGuirk, William R Drobyski, Bita Jalilizeinali and H Jean Khoury. Geoffrey L Uy’s contribution is supported by NCI grant K23 CA140707. The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two grants N00014-12-1-0142 and N00014-13-1-0039 from the Office of Naval Research; and grants from *Actinium Pharmaceuticals, Allos Therapeutics, Inc. and *Amgen, Inc. Anonymous donation to the Medical College of Wisconsin, Ariad, Be the Match Foundation, *Blue Cross and Blue Shield Association, *Celgene Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Fresenius-Biotech North America, Inc., *Gamida Cell Teva Joint Venture Ltd., Genentech, Inc.,*Gentium SpA, Genzyme Corporation, GlaxoSmithKline, Health Research, Inc., Roswell Park Cancer Institute, HistoGenetics, Inc., Incyte Corporation, Jeff Gordon Children’s Foundation, Kiadis Pharma, The Leukemia & Lymphoma Society, Medac GmbH, The Medical College of Wisconsin, Merck & Co, Inc., Millennium: The Takeda Oncology Co., *Milliman USA, Inc., *Miltenyi Biotec, Inc., National Marrow Donor Program, Onyx Pharmaceuticals, Optum Healthcare Solutions, Inc., Osiris Therapeutics, Inc., Otsuka America Pharmaceutical, Inc., Perkin Elmer, Inc., *Remedy Informatics, *Sanofi US, Seattle Genetics, Sigma-Tau Pharmaceuticals, Soligenix, Inc., St Baldrick’s Foundation, StemCyte, A Global Cord Blood Therapeutics Co., Stemsoft Software, Inc., Swedish Orphan Biovitrum, *Tarix Pharmaceuticals, *TerumoBCT, *Teva Neuroscience, Inc., *THERAKOS, Inc., University of Minnesota, University of Utah and *Wellpoint, Inc. *Corporate members. The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration (HRSA) or any other agency of the U.S. Government.

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Authors and Affiliations

  1. St Louis University Medical Center, St Louis, MO, USA

    S D Goyal

  2. Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA

    M-J Zhang, H-L Wang, M Hamadani & W Saber

  3. Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA

    M-J Zhang

  4. Section of Hematology Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ, USA

    G Akpek

  5. Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA

    E A Copelan

  6. South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, TX, USA

    C Freytes

  7. Division of Experimental Medicine, Department of Medicine, Hematology Research Centre, Imperial College London, London, UK

    R P Gale

  8. National Cancer Center Hospital, Tokyo, Japan

    Y Inamoto

  9. Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA

    R T Kamble

  10. Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA

    H M Lazarus & M de Lima

  11. Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK

    D I Marks

  12. Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    T Nishihori

  13. Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden

    R F Olsson

  14. Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden

    R F Olsson

  15. Department of Medicine, Abramson Cancer Center, University of Pennsylvania Medical Center, Philadelphia, PA, USA

    R Reshef

  16. Royal Melbourne Hospital, Melbourne, VIC, Australia

    D S Ritchie

  17. Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    B N Savani

  18. Hospital Samaritano, Sao Paulo, Brazil

    A Seber

  19. Division of Hematology and Oncology, Department of Medicine, University of North Carolina Health Care, Chapel Hill, NC, USA

    T C Shea

  20. Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    M S Tallman

  21. Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA

    B Wirk

  22. Department of Internal Medicine III, Universitätsklinikum Ulm, Ulm, Germany

    D W Bunjes

  23. Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center—James, Columbus, OH, USA

    S M Devine

  24. Division of Hematology, Department of Medicine, Oncology and Transplantation, University of Minnesota Medical Center, Minneapolis, MN, USA

    D J Weisdorf

  25. Department of Medicine, Washington University School of Medicine, St Louis, MO, USA

    G L Uy

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  1. S D Goyal
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  2. M-J Zhang
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  4. G Akpek
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  7. R P Gale
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  8. M Hamadani
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  9. Y Inamoto
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  10. R T Kamble
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  11. H M Lazarus
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  13. T Nishihori
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  14. R F Olsson
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  15. R Reshef
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  16. D S Ritchie
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  17. W Saber
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  18. B N Savani
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  19. A Seber
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  20. T C Shea
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  21. M S Tallman
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  22. B Wirk
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  23. D W Bunjes
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  24. S M Devine
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  25. M de Lima
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  26. D J Weisdorf
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  27. G L Uy
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for the Acute Leukemia Working Committee of the Center for International Blood and Marrow Transplant Research

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Correspondence to G L Uy.

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The authors declare no conflict of interest.

Additional information

Presented in part at the 2014 BMT Tandem Meetings, Grapevine, TX, 2 March 2014.

Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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Goyal, S., Zhang, MJ., Wang, HL. et al. Allogeneic hematopoietic cell transplant for AML: no impact of pre-transplant extramedullary disease on outcome. Bone Marrow Transplant 50, 1057–1062 (2015). https://doi.org/10.1038/bmt.2015.82

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