Allogeneic hematopoietic cell transplantation improves outcome of adults with t(6;9) acute myeloid leukemia: results from an international collaborative study

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Authors	KAYSER Sabine HILLS Robert K. LUSKIN Marlise R. BRUNNER Andrew M. TERRE Christine WESTERMANN Jorg MENGHRAJANI Kamal SHAW Carole BAER Maria R. ELLIOTT Michelle A. PERL Alexander E. RÁČIL Zdeněk MAYER Jiří ZAK Pavel SZOTKOWSKI Tomas DE BOTTON Stephane GRIMWADE David MAYER Karin WALTER Roland B. KRAMER Alwin BURNETT Alan K. HO Anthony D. PLATZBECKER Uwe THIEDE Christian EHNINGER Gerhard STONE Richard M. ROLLIG Christoph TALLMAN Martin S. ESTEY Elihu H. MULLER-TIDOW Carsten RUSSELL Nigel H. SCHLENK Richard F. LEVIS Mark J.
Year of publication	2020
Type	Article in Periodical
Magazine / Source	Haematologica
MU Faculty or unit	Faculty of Medicine
Citation
web	http://dx.doi.org/10.3324/haematol.2018.208678
Doi	http://dx.doi.org/10.3324/haematol.2018.208678
Keywords	HIGH-DOSE CYTARABINE; ACUTE MYELOGENOUS LEUKEMIA; FLT3 GENE; AML; T(6/9)(P23_Q34); INDUCTION; CONSOLIDATION; CHEMOTHERAPY; PROGNOSIS; SURVIVAL
Description	A cute myeloid leukemia (AML) with t(6;9)(p22;q34) is a distinct entity accounting for 1-2% of AML cases. A substantial proportion of these patients have a concomitant FLT3-ITD. While outcomes are dismal intensive chemotherapy, limited evidence suggests allogeneic hematopoietic cell transplantation (allo-HCT) may improve survival if performed early during first complete remission. We report on a cohort of 178 patients with t(6;9)(p22;q34) within an international, multicenter collaboration. Median age was 46 years (range: 16-76), AML was de novo in 88%, FLT3-ITD was present in 62%, and additional cytogenetic abnormalities in 21%. Complete remission was achieved in 81% (n=144), including 14 patients who received high-dose cytarabine after initial induction failure. With a median follow up of 5.43 years, estimated overall survival at five years was 38% (95%CI: 31-47%). Allo-HCT was performed in 117 (66%) patients, including 89 in first complete remission. Allo-HCT in first complete remission was associated with higher 5-year relapse-free and overall survival as compared to consolidation chemotherapy: 45% (95%CI: 35-59%) and 53% (95%CI: 42-66%) versus 7% (95%CI: 3-19%) and 23% (95%CI: 13-38%), respectively. For patients undergoing allo-HCT, there was no difference in overall survival rates at five years according to whether it was performed in first [53% (95%CI: 42-66%)], or second [58% (95%CI: 31-100%); n=10] complete remission or with active disease/relapse [54% (95%CI: 34-84%); n=18] (P=0.67). Neither FLT3-ITD nor additional chromosomal abnormalities impacted survival. In conclusion, outcomes of t(6;9)(p22;q34) AML are poor with chemotherapy, and can be substantially improved with allo-HCT.
Related projects:	Národní program studia mutací a klonality leukemických buněk u pacientů s akutní myeloidní leukémií