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Outcomes of older patients aged 60 to 70 years undergoing reduced intensity transplant for acute myeloblastic leukaemia: results of the NCRI acute myeloid leukemia 16 trial

Russell, Nigel H., Hills, Robert K., Thomas, Abin, Thomas, Ian, Kjeldsen, Lars, Dennis, Mike, Craddock, Charles, Freeman, Sylvie, Clark, Richard E. and Burnett, Alan K. 2022. Outcomes of older patients aged 60 to 70 years undergoing reduced intensity transplant for acute myeloblastic leukaemia: results of the NCRI acute myeloid leukemia 16 trial. Haematologica 107 (7) , pp. 1518-1527. 10.3324/haematol.2021.279010

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Abstract

Reduced Intensity Conditioning (RIC) transplantation is increasingly offered to older patients with acute myeloblastic leukemia (AML). We have previously shown that a RIC allograft, particularly from a sibling donor is beneficial in intermediate risk patients aged 35-65 years. We here present analyses from the NCRI AML16 trial extending this experience to older patients aged 60-70 inclusive lacking favorable risk cytogenetics 932 patients were studied, with RIC transplant in first remission given to 144 (sibling n=52, MUD n=92) with median follow-up for survival from CR of 60 months. Comparisons of transplant versus not are carried out using Mantel-Byar analysis. Among the 144 allografts, 93 had intermediate risk cytogenetics, 18 adverse and 33 were unknown. In transplanted patients survival was 37% at 5 years, and while the survival for siblings (44%) was better than that for MUDs (34%) this was not significant (p=0.2). When comparing RIC versus chemotherapy survival was significantly improved (37% vs 20%, HR 0.67 (0.53-0.84) p<0.001). When stratified by Wheatley risk group into good, standard and poor risk there was consistent benefit for RIC across risk groups. When stratified by post course-1 flow MRD status there was consistent benefit for allograft. The benefit for RIC was seen in patients with a FLT3 ITD or NPM1 mutation with no evidence of a differential effect by genotype. We conclude that RIC transplant is an attractive option for older AML patients lacking favorable risk cytogenetics and in this study, we could not find a group that did not benefit.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Centre for Trials Research (CNTRR)
Additional Information: Haematologica material is published under a CC BY-NC license
Publisher: Ferrata Storti Foundation
ISSN: 1592-8721
Date of First Compliant Deposit: 17 November 2021
Date of Acceptance: 19 August 2021
Last Modified: 14 Jul 2022 14:00
URI: https://orca.cardiff.ac.uk/id/eprint/145580

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