Abstract 2037

Acute Myeloid Leukemia(AML) in elderly patients is associated with a poor outcome even for patients able to receive intensive chemotherapy. Relapse rate remain elevated around 60 to 80% at 3 years especially in case of unfavourable cytogenetics. From more than 10 years, the approach of RIC-alloSCT has permitted to extend the age limit of transplant in this population. However, feasibility remains controversial for patient aged of 60 years or more because of more frequent co-morbidities translating into an higher risk of treatment related mortality (TRM). To address the question of feasibility and results of RIC-alloSCT in AML patients of 60 years or more in a intend to treat manner approach, we have conducted a retrospective bi-centric analysis based on a comparison “donor” versus “no donor” for patient in first complete remission (CR1).

Methods:

96 AML were included, all have received a 3+7 or equivalent induction regimen, between 2001–2009 in two different French centers and have benefited of an HLA typing in CR1. All patients of the “donor” group are considered for a RIC-alloSCT after one or two courses of consolidation.

Results:

The “donor” group is constitute of 30 patients with a median age of 65.5 years and with an HLA identical donor identified. Eighteen 60%) have been finally transplanted with a median period of 188 days from diagnosis to graft. The “no donor” group is constituted by 66 patients with a median age of 68.5. The two groups are similar considering cytogenetics risk and haematological features of the disease.

Median follow up is 48 months for alive patients. No difference of overall survival (OS) or Leukemia free survival (LFS) has been observed between the ”donor” and “no donor group” (respectively 51% vs 44%, p=0.7 and 35%vs 32%, p=0.27). When restricting analysis to the patient who could actually received the RIC allo-SCT, the transplant group (n=18) has a significant better outcome for both OS and LFS as compared to the “non transplant” (n=78) group (69% vs 32% and 52% vs 29% respectively). In the transplant group, no patient died from transplant-related mortality. Acute and extensive chronic graft versus host disease (aGVHD and cGVHD) occurred respectively in 5/18 and in 8/18 patients of the “transplant” group.

Conclusion:

In a intend to treat manner, RIC-alloSCT provides similar outcome as compared to chemotherapy alone in this series of 96 patients. However, both OS and LFS are significantly improved for patients who have actually received RIC-alloSCT. Toxicity appears to be limited in the “transplant” group. Recruiting patients in this study is still ongoing and final results will be presented at the congress.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
allogeneic stem cell transplant, donors, leukemia, myelocytic, acute, older adult, conditioning (psychology), transplantation, chemotherapy regimen, graft-versus-host disease, chronic, allopurinol, complete remission

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Author notes

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Asterisk with author names denotes non-ASH members.

© 2012 by The American Society of Hematology
2012
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