Acute Myelogenous Leukemia (AML) Outcomes

The survival graphs below illustrate outcomes of unrelated donor hematopoietic cell transplants (bone marrow, PBSC, or cord blood transplants — BMT) coordinated by the National Marrow Donor Program (NMDP) for both adult and pediatric patients.

NMDP outcomes for adult AML patients

Five-year survival for adult patients (> 18 years of age) transplanted for acute myelogenous leukemia (AML) using marrow (Figure 1) or peripheral blood stem cells (PBSC) (Figure 2) is significantly increased in patients transplanted in first or second complete remission compared to those patients transplanted with advanced disease (log-rank p-value < 0.0001). Unrelated transplant for AML in first complete remission is indicated if the patient has poor-risk cytogenetics at diagnosis or induction failure.

In a 2007 study of 261 AML patients undergoing matched unrelated donor transplantation, cytogenetic risk factors had no effect on five-year overall survival and DFS for patients in first complete remission. In second complete remission, there was a non-significant trend toward better survival for patients with favorable cytogenetics. The researchers concluded that matched unrelated donor transplantation should be considered for patients with unfavorable cytogenetics lacking a suitable HLA-matched sibling donor. [1]

A large-scale, multi-center phase III clinical trial is underway to determine if graft source (PBSC or marrow) affects transplant outcomes in unrelated donor transplantation for AML and other hematologic malignancies. The trial is being conducted through the Blood and Marrow Transplant Clinical Trials Network (BMT CTN Study 0201). [2]

Figure 1.
Acute myelogenous leukemia: Survival of adult marrow myeloablative transplant patients by disease stage 1998-2006. (NMDP data)

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AML adult marrow myeloablative transplants facilitated by the NMDP, 1998-2006
Disease Stage	# of Transplants	Kaplan-Meier 5-Year Survival*
1st complete remission	274	33% ± 6%
2nd complete remission	264	35% ± 7%
Advanced disease	479	15% ± 3%

* 95% confidence interval

Figure 2.
Acute myelogenous leukemia: Survival of adult PBSC myeloablative transplant patients by disease stage 1998-2006. (NMDP data)

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AML adult PBSC myeloablative transplants facilitated by the NMDP, 1998-2006
Disease Stage	# of Transplants	Kaplan-Meier 5-Year Survival*
1st complete remission	352	44% ± 7%
2nd complete remission	200	40% ± 10%
Advanced disease	363	15% ± 6%

* 95% confidence interval

NMDP outcomes for pediatric AML patients

Five-year survival for pediatric patients (<18 years of age) transplanted for AML is significantly increased for those patients transplanted in second complete remission compared to those transplanted in first complete remission or with advanced disease. However, a greater percent of patients transplanted in first complete remission had poor-risk cytogenetics compared to those patients who were transplanted in second complete remission (log-rank p-value < 0.0004). Unrelated transplant for AML in first complete remission is indicated if the patient has poor-risk cytogenetics at diagnosis or induction failure.

 

Figure 3.
Acute myelogenous leukemia: Survival of pediatric myeloablative marrow transplant patients by disease stage 1998-2006. (NMDP data)


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AML pediatric myeloablative marrow transplants facilitated by the NMDP, 1998-2006
Disease Stage	# of Transplants	Kaplan-Meier 5-Year Survival*
1st complete remission	98	31% ± 11%
2nd complete remission	137	51% ± 9%
Advanced disease	116	29% ± 9%

* 95% confidence interval

NMDP outcomes for adult AML patients > age 55

Due to their lowered toxicity, non-myeloablative or reduced-intensity transplants have expanded the number of patients eligible for hematopoietic cell transplantation. For more information, see Advances in Conditioning Regimens. Figure 4 shows five-year survival for adult patients 55 years of age or older undergoing non-myeloablative transplantation for AML.

 

Figure 4.
Acute myelogenous leukemia: Survival of non-myeloablative marrow and PBSC transplant patients > 55 years old by disease stage 1998-2006. (NMDP data)


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AML marrow and PBSC non-myeloablative transplants of adults > age 55 facilitated by the NMDP, 1998-2006
Disease Stage	# of Transplants	Kaplan-Meier 5-Year Survival*
1st complete remission	239	27% ± 8%
2nd complete remission	107	30% ± 14%
Advanced disease	113	14% ± 8%

* 95% confidence interval

Due to advances in supportive care, an increasing number of patients 55 years and older are undergoing myeloablative transplantation. Figure 5 shows results in these patients transplanted using unrelated donors from the NMDP.

Figure 5.
Acute myelogenous leukemia: Survival of myeloablative marrow and PBSC transplant patients > 55 years old by disease stage 1998-2006. (NMDP data)


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AML marrow and PBSC myeloablative transplants of adults > age 55 facilitated by the NMDP, 1998-2006
Disease Stage	# of Transplants	Kaplan-Meier 5-Year Survival*
1st complete remission	82	39% ± 15%
2nd complete remission	44	36% ± 19%
Advanced disease	69	19% ± 11%

* 95% confidence interval

References

1. Tallman MS, Dewald GW, Gandham S, et al. Impact of cytogenetics on outcome of matched unrelated donor hematopoietic stem cell transplantation for acute myeloid leukemia in first or second complete remission. Blood. 2007; 110(1):409-417.
   http://bloodjournal.hematologylibrary.org/cgi/content/abstract
   /110/1/409
2. BMT CTN Protocol 0201 - A Phase III randomized multicenter trial comparing G-CSF mobilized peripheral blood stem cell with marrow transplantation from HLA compatible unrelated donors.
   https://web.emmes.com/study/bmt/protocol/0201__protocol/
   0201__protocol.html