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Salvage therapy for acute chemorefractory leukemia by allogeneic stem cell transplantation: the Korean experience

Authors
 Shin Hye Yoo  ;  Youngil Koh  ;  Dae-Young Kim  ;  Jung-Hee Lee  ;  Je-Hwan Lee  ;  Kyoo-Hyung Lee  ;  Sung-Soo Yoon  ;  Seonyang Park  ;  Sung-Kyu Park  ;  Dae-Sik Hong  ;  Hyeon Gyu Yi  ;  Chul-Soo Kim  ;  Ji Eun Jang  ;  June-Won Cheong  ;  Joonho Moon  ;  Yoo Hong Min  ;  Sang Kyun Sohn  ;  Inho Kim 
Citation
 Annals of Hematology, Vol.96(4) : 605-615, 2017 
Journal Title
 Annals of Hematology 
ISSN
 0939-5555 
Issue Date
2017
MeSH
Acute Disease ; Adult ; Female ; Graft vs Host Disease/diagnosis* ; Graft vs Host Disease/mortality ; Graft vs Host Disease/therapy* ; Hematopoietic Stem Cell Transplantation/methods* ; Hematopoietic Stem Cell Transplantation/mortality ; Humans ; Leukemia/diagnosis* ; Leukemia/mortality ; Leukemia/therapy* ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies ; Salvage Therapy/methods* ; Salvage Therapy/mortality ; Survival Rate/trends ; Transplantation, Homologous
Keywords
Acute leukemia ; Allogeneic hematopoietic stem cell transplantation ; Chemorefractoriness ; Graft-versus-host disease
Abstract
Little is known about the characteristics that make patients with acute leukemia suitable for undergoing salvage therapy by allogeneic hematopoietic stem cell transplantation (allo-HSCT). Here, we analyzed the clinical outcomes of 223 patients with acute leukemia who underwent allo-HSCT while not in complete remission (CR). The primary end points were overall survival (OS) and CR rate. CR was achieved in 79.8% of patients after allo-HSCT. Acute graft-versus-host disease (GVHD) was significantly associated with CR (P = 0.045). During a median follow-up of 30.1 months, the median OS was 6.1 months. OS was significantly longer in patients with good or standard risk cytogenetic characteristics than in those with poor risk cytogenetic characteristics (P = 0.029, P = 0.030, respectively). Patients who received allo-HSCT from a matched sibling donor had better survival than those with unrelated donors (P = 0.015). Primary chemorefractoriness was not associated with poor survival (P = 0.071). The number of chemotherapies before allo-HSCT was significantly correlated with outcome (P = 0.006). Chronic GVHD was a strong predictor of a longer OS (P = 0.025). In conclusion, survival of patients with primary chemorefractory acute leukemia is not lower when treated upfront with allo-HSCT. Hence, allo-HSCT should be actively considered in such patients. Acute and chronic GVHD is associated with better outcomes patients with acute leukemia who have undergone allo-HSCT and not achieved CR.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/161138
DOI
10.1007/s00277-017-2919-8
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
민유홍(Min, Yoo Hong) ; 장지은(Jang, Ji Eun) ; 정준원(Cheong, June-Won)
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Full Text
https://link.springer.com/article/10.1007%2Fs00277-017-2919-8
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