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Allogeneic Hematopoietic Cell Transplant for Adult Chronic Myelomonocytic Leukemia.

Research paper by Hien D HD Liu, Kwang Woo KW Ahn, Zhen-Huan ZH Hu, Mehdi M Hamadani, Taiga T Nishihori, Baldeep B Wirk, Amer A Beitinjaneh, David D Rizzieri, Michael R MR Grunwald, Mitchell M Sabloff, Richard F RF Olsson, Ashish A Bajel, Christopher C Bredeson, Andrew A Daly, Yoshihiro Y Inamoto, et al.

Indexed on: 25 Jan '17Published on: 25 Jan '17Published in: Biology of Blood and Marrow Transplantation



Abstract

Allogeneic hematopoietic cell transplantation (HCT) is potentially curative for patients with chronic myelomonocytic leukemia (CMML), however, few data exist regarding prognostic factors and transplant outcomes. We performed this retrospective study to identify prognostic factors for post-transplant outcomes. The CMML-specific prognostic scoring system (CPSS) has been validated in subjects receiving non-transplant therapy and was included in our study. From 2001-2012, there were 209 adult subjects who received HCT for CMML reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). The median age at transplant was 57 years (range 23-74). Median follow up was 51 months (range, 3-122). On multivariate analyses, CPSS scores, Karnofsky performance status (KPS), and graft source were significant predictors of survival (p=0.004, p=0.01, p=0.01, respectively). Higher CPSS scores were not associated with disease-free survival, relapse, or transplant-related mortality. In a restricted analysis of subjects with relapse following HCT, those with intermediate-2/high risk had a nearly two-fold increased risk of death after relapse compared to those with low/intermediate-1 CPSS scores. Respective 1, 3 and 5-year survival rates for low/intermediate-1 risk subjects were 61% (95% confidence interval [CI], 52%-72%), 48% (95% CI, 37%-59%), and 44% (95% CI, 33%-55%), and for intermediate-2/high risk subjects were 38% (95% CI, 28%-49%), 32% (95% CI, 21% - 42%), and 19% (95% CI,8%-29%). We conclude that higher CPSS score at time of transplant, lower KPS, and a bone marrow (BM) graft are associated with inferior survival after HCT. Further investigation of CMML disease-related biology may provide insights into other risk factors predictive of post-transplant outcomes.

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