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

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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.

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Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, South Korea

    Shin Hye Yoo, Youngil Koh, Sung-Soo Yoon, Seonyang Park & Inho Kim

  2. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Dae-Young Kim, Jung-Hee Lee, Je-Hwan Lee & Kyoo-Hyung Lee

  3. Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea

    Sung-Kyu Park & Dae-Sik Hong

  4. Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea

    Hyeon Gyu Yi & Chul-Soo Kim

  5. Department of Internal Medicine, Yonsei University Severance Hospital, 250 Sungsan-ro, Seodaemun-gu, Seoul, 120-752, South Korea

    Ji Eun Jang, June-Won Cheong & Yoo Hong Min

  6. Department of Internal Medicine, Kyung-Pook University Hospital, Daegu, South Korea

    Joonho Moon & Sang Kyun Sohn

  7. Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 200 Dongduk-ro, Jung-gu, Daegu, 700-721, South Korea

    Sang Kyun Sohn

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  1. Shin Hye Yoo
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for the Korean Society of Blood and Marrow Transplantation

Corresponding authors

Correspondence to Yoo Hong Min, Sang Kyun Sohn or Inho Kim.

Ethics declarations

This study was approved by the individual institutional review boards of all participating institutions. All procedures were carried out according to the principles of the Declaration of Helsinki. Patients’ consent to participate was waived according to the Institutional Review Board because of the retrospective design of this study.

Conflict of interest

This work was supported by a Korean Association of Internal Medicine Research Grant 2013. No other potential conflict of interest exists.

Authorship statement

S.H.Y. contributed to writing the manuscript and analyzing the data with Y.K. Y.K., I.K., D.-Y.K., Y.H.M., and S.K.S. designed the study and interpreted the results. Y.K., I.K., J.-H.K., S.-S.Y., S.P., J.M., S.K.S., D.S.H., S.-K.P., H.G.Y., C.-S.K., J.-H.L., J.-H.L., K.-H.L., D.-Y.K., C.-W.C., Y.H.M., and J.E. J treated several patients and checked the final version of the manuscript.

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Shin Hye Yoo, Youngil Koh, and Dae-Young Kim contributed equally to this work.

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Yoo, S.H., Koh, Y., Kim, DY. et al. Salvage therapy for acute chemorefractory leukemia by allogeneic stem cell transplantation: the Korean experience. Ann Hematol 96, 605–615 (2017). https://doi.org/10.1007/s00277-017-2919-8

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