TY - JOUR
T1 - Treatment with Hypomethylating Agents before Allogeneic Stem Cell Transplant Improves Progression-Free Survival for Patients with Chronic Myelomonocytic Leukemia
AU - Kongtim, Piyanuch
AU - Popat, Uday
AU - Jimenez, Antonio
AU - Gaballa, Sameh
AU - El Fakih, Riad
AU - Rondon, Gabriela
AU - Chen, Julianne
AU - Bueso-Ramos, Carlos
AU - Borthakur, Gautam
AU - Pemmaraju, Naveen
AU - Garcia-Manero, Guillermo
AU - Kantarjian, Hagop
AU - Alousi, Amin
AU - Hosing, Chitra
AU - Anderlini, Paolo
AU - Khouri, Issa F.
AU - Kebriaei, Partow
AU - Andersson, Borje S.
AU - Oran, Betul
AU - Rezvani, Katayoun
AU - Marin, David
AU - Shpall, Elizabeth J.
AU - Champlin, Richard E.
AU - Ciurea, Stefan O.
N1 - Publisher Copyright:
© 2016 American Society for Blood and Marrow Transplantation.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - The treatment of patients with chronic myelomonocytic leukemia (CMML) with transplant has not been optimized. We retrospectively reviewed the data for 83 consecutive patients with CMML (47 with CMML-1/2 and 36 with CMML progressed to acute myeloid leukemia) who received an allogeneic stem cell transplant (allo-SCT) at our institution between April 1991 and December 2013 to identify factors associated with improved survival and determine whether treatment with hypomethylating agents before transplant improves progression-free survival (PFS). The median age of the cohort was 57 years. Seventy-eight patients received induction treatment before transplant, with 37 receiving hypomethylating agents and 41 receiving cytotoxic chemotherapy. Patients treated with a hypomethylating agent had a significantly lower cumulative incidence of relapse at 3 years post-transplant (22%) than those treated with other agents (35%; P = .03), whereas treatment-related mortality at 1 year post-transplant did not significantly differ between the groups (27% and 30%, respectively; P = .84). The lower relapse rate resulted in a significantly higher 3-year PFS rate in patients treated with a hypomethylating agent (43%) than in those treated with other agents (27%; P = .04). Our data support the use of hypomethylating agents before allo-SCT for patients with CMML to achieve morphologic remission and improve PFS of these patients. Future studies are needed to confirm these findings.
AB - The treatment of patients with chronic myelomonocytic leukemia (CMML) with transplant has not been optimized. We retrospectively reviewed the data for 83 consecutive patients with CMML (47 with CMML-1/2 and 36 with CMML progressed to acute myeloid leukemia) who received an allogeneic stem cell transplant (allo-SCT) at our institution between April 1991 and December 2013 to identify factors associated with improved survival and determine whether treatment with hypomethylating agents before transplant improves progression-free survival (PFS). The median age of the cohort was 57 years. Seventy-eight patients received induction treatment before transplant, with 37 receiving hypomethylating agents and 41 receiving cytotoxic chemotherapy. Patients treated with a hypomethylating agent had a significantly lower cumulative incidence of relapse at 3 years post-transplant (22%) than those treated with other agents (35%; P = .03), whereas treatment-related mortality at 1 year post-transplant did not significantly differ between the groups (27% and 30%, respectively; P = .84). The lower relapse rate resulted in a significantly higher 3-year PFS rate in patients treated with a hypomethylating agent (43%) than in those treated with other agents (27%; P = .04). Our data support the use of hypomethylating agents before allo-SCT for patients with CMML to achieve morphologic remission and improve PFS of these patients. Future studies are needed to confirm these findings.
KW - Allogeneic stem cell transplantation
KW - Chronic myelomonocytic leukemia
KW - Hypomethylating agents
KW - Myeloproliferative neoplasms
KW - Secondary acute myeloid leukemia
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U2 - 10.1016/j.bbmt.2015.08.031
DO - 10.1016/j.bbmt.2015.08.031
M3 - Article
C2 - 26343946
AN - SCOPUS:84952638929
SN - 1083-8791
VL - 22
SP - 47
EP - 53
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 1
ER -