Long term impact of hyperleukocytosis in newly diagnosed acute myeloid leukemia patients undergoing allogeneic stem cell transplantation: an analysis from the acute leukemia working party of the EBMT.
Fiche publication
Date publication
mars 2017
Journal
American journal of hematology
Auteurs
Membres identifiés du Cancéropôle Est :
Pr DECONINCK Eric
Tous les auteurs :
Canaani J, Labopin M, Socié G, Nihtinen A, Huynh A, Cornelissen J, Deconinck E, Gedde-Dahl T, Forcade E, Chevallier P, Bourhis JH, Blaise D, Mohty M, Nagler A
Lien Pubmed
Résumé
Up to 20% of acute myeloid leukemia (AML) patients present initially with hyperleukocytosis, placing them at increased risk for early mortality during induction. Yet, it is unknown whether hyperleukocytosis still retains prognostic value for AML patients undergoing hematopoietic stem cell transplantation (HSCT). Furthermore, it is unknown whether hyperleukocytosis holds prognostic significance when modern molecular markers such as FLT3-ITD and NPM1 are accounted for. To determine whether hyperleukocytosis is an independent prognostic factor influencing outcome in transplanted AML patients we performed a retrospective analysis using the registry of the acute leukemia working party of the EBMT. A cohort of 357 patients with hyperleukocytosis (159 patients with WBC 50K-100K, 198 patients with WBC≥100K) was compared to 918 patients without hyperleukocytosis. Patients with hyperleukocytosis were younger, had an increased rate of favorable risk cytogenetics, and more likely to be FLT3 and NPM1 mutated. In multivariate analysis, hyperleukocytosis was independently associated with increased relapse incidence (hazard ratio [HR] of 1.55, 95% confidence interval [CI], 1.14 - 2.12; p=0.004), decreased leukemia-free survival (HR of 1.38, 95% CI, 1.07 - 1.78; p=0.013), and inferior overall survival (HR of 1.4, 95% CI, 1.07 - 1.84; p=0.013). Hyperleukocytosis retains a significant prognostic role for AML patients undergoing HSCT. This article is protected by copyright. All rights reserved.
Mots clés
Adolescent, Adult, Aged, Biomarkers, Tumor, Female, Follow-Up Studies, Graft vs Host Disease, epidemiology, Hematopoietic Stem Cell Transplantation, methods, Humans, Incidence, Leukemia, Myeloid, Acute, blood, Leukocyte Count, Leukocytosis, blood, Male, Middle Aged, Mutation, Nuclear Proteins, genetics, Prognosis, Proportional Hazards Models, Recurrence, Retrospective Studies, Transplantation, Homologous, Treatment Outcome, Young Adult, fms-Like Tyrosine Kinase 3, genetics
Référence
Am. J. Hematol.. 2017 Mar;: