Allogeneic stem cell transplantation remains an effective therapeutic approach for patients with therapy-related acute myeloid leukemia

Abstract

Introduction: Therapy-related acute myeloid leukemia (t-AML) remains a late consequence of exposure to cytotoxic chemo- and/or radiotherapy for prior malignant or non-malignant disorders. The prognosis of t-AML is extremely poor, and allogeneic stem cell transplantation (allo-SCT) seems to be the most effective therapeutic approach.We evaluated the efficacy and safety of allo-SCT for t-AML preceded by solid tumors and lymphomas. Material and methods: Study patients were retrospectively identified using our institutional database. Nineteen patients (12 female, 7 male), median age 53 years, underwent allo-SCT for t-AML between 2006 and 2018. Results: Prior malignancy was diagnosed at median age of 43.9 years. Among 19 patients included in the study, 6 (32%) had prior breast cancer, 2 (11%) were diagnosed with papillary thyroid cancer, and 2 (11%) were treated for lymphoma. A variety of other cancers were diagnosed in the remaining 9 patients. Median time from previous malignancy to development of t-AML was 4.9 years. Fourteen patients (74%) were transplanted in first complete remission (CR1), 4 patients (21%) were in CR2, and 1 patient received graft being in active disease. 10 patients (53%) are alive at last contact in CR. Patients died mainly from infectious complications. Median follow-up from prior malignancy and from transplantation was 9.5 years and 1.82 years, respectively. The 2-year overall survival (OS) was 57%. Median OS for survivors is 4.08 years. Grafts from unrelated donors and the presence of acute graft-versus-host disease affected OS. Conclusions: Allo-SCT remains an effective therapy for t-AML.