Skip to main content

Central Nervous System Involvement at the Time of Allogeneic Hematopoietic Stem Cell Transplantation Is Associated with a Poor Outcome in Patients with Acute Myeloid Leukemia

Abstract

Recent reports suggested that central nervous system (CNS) involvement (CNS+) in patients with acute myeloid leukemia (AML) before allogeneic hematopoietic stem cell transplantation (allo-HSCT) is not an independent predictor of survival after allo-HSCT. However, these studies did not analyze minimal residual disease in the CNS at the time of allo-HSCT. We evaluated the effect of residual CNS+ on the transplant outcomes of 214 AML patients in a single institution. Twenty-one (10%) patients were diagnosed with CNS+ prior to allo-HSCT. Of these, 13 patients had CNS disease at the time of allo-HSCT. The patients in CNS+ AML remission at the time of allo-HSCT had better overall survival (OS) than the patients who were not in remission (2-year OS: 55% vs. 7.7%, p = 0.0001). In multivariate analyses, CNS+ at the time of allo-HSCT (hazard ratio (HR), 1.9; 95% confidence interval (CI), 1.05–3.59; p = 0.04), age over 50 years at the time of allo-HSCT, and non-complete remission disease status in bone marrow at the time of allo-HSCT were independent adverse factors for OS. However, a prior history of CNS+ before allo-HSCT did not independently affect OS (HR, 1.27; 95% CI 0.53–2.07; p = 0.6). Early diagnosis and eradication of CNS+ at the time of allo-HSCT may be necessary to improve the outcome for patients with CNS+ AML.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Bommer M, von Harsdorf S, Döhner H, Bunjes D, Ringhoffer M (2010) Neoplastic meningitis in patients with acute myeloid leukemia scheduled for allogeneic hematopoietic stem cell transplantation. Haematologica 11:1969–1972

    Article  Google Scholar 

  2. Sanders KE, Ha CS, Cortes-Franco JE, Koller CA, Kantarjian HM, Cox JD (2004) The role of craniospinal irradiation in adults with a central nervous system recurrence of leukemia. Cancer 100:2176–2180

    Article  PubMed  Google Scholar 

  3. Mayadev JS, Douglas JG, Storer BE, Appelbaum FR, Storb R (2011) Impact of cranial irradiation added to intrathecal conditioning in hematopoietic cell transplantation in adult acute myeloid leukemia with central nervous system involvement. Int J Radiat Oncol Biol Phys 80:193–198

    Article  PubMed  Google Scholar 

  4. Aoki J, Ishiyama K, Taniguchi S et al (2014) Outcome of allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia patients with central nervous system involvement. Biol Blood Marrow Transplant 20:2029–2033

    Article  PubMed  Google Scholar 

  5. Bar M, Tong W, Othus M, Loeb KR, Estey EH (2015) Central nervous system involvement in acute myeloid leukemia patients undergoing hematopoietic cell transplantation. Biol Blood Marrow Tranplant 21:546–551

    Article  Google Scholar 

  6. Pui CH, Thiel E (2009) Central nervous system disease in hematologic malignancies: historical perspective and practical applications. Semin Oncol 36:S2–S16

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. Ruutu T, Corradini P, Gratwohl A et al (2005) Use of intrathecal prophylaxis in allogeneic haematopoietic stem cell transplantation for malignant blood diseases: a survey of the European Group for Blood and Marrow Transplantation EBMT. Bone Marrow Transplant 35:121–124

    CAS  Article  PubMed  Google Scholar 

  8. Oshima K, Kanda Y, Yamashita T et al (2008) Central nervous system relapse of leukemia after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 14:1100–1107

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Noriko Doki.

Ethics declarations

Financial Disclosure

The authors have nothing to disclose.

Conflict of Interest

The authors have no conflicts of interest.

Electronic supplementary material

Supplementary table 1

Patients in the CNS + AML group. (TIFF 1521 kb)

High resolution image (GIF 188 kb)

Supplementary table 2

Cytogenetic data of patients in the CNS + AML group. (TIFF 78 kb)

High resolution image (GIF 137 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ikegawa, S., Doki, N., Kaito, S. et al. Central Nervous System Involvement at the Time of Allogeneic Hematopoietic Stem Cell Transplantation Is Associated with a Poor Outcome in Patients with Acute Myeloid Leukemia. Pathol. Oncol. Res. 23, 433–437 (2017). https://doi.org/10.1007/s12253-016-0162-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12253-016-0162-6

Keywords

  • Central nervous system involvement
  • Allogeneic hematopoietic stem cell transplantation
  • Acute myeloid leukemia