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Master Thesis

Allogreffe de cellules souches hématopoïétiques dans la leucémie aiguë myéloïde évolutive de l’adulte : analyse rétrospective de l’expérience grenobloise

Abstract : Introduction. Achieving first complete remission in acute myeloid leukemia (AML) at diagnosis is a reachable outcome for up to 50 to 70% of patients. Nevertheless, some of them fail to do so and the refractoriness of the disease is responsible for a dismal prognosis. Although its place is quite debated, hematopoietic stem cell transplantation (HSCT) seems to be, today, the unique curative option in these situations. Our study focuses on the outcome of patients who underwent HSCT for refractory/relapsed and evolutive AML with persistence of blastic infiltration, at Grenoble University Hospital form 2007 to 2017. Methods. Adults receiving HSCT for evolutive AML with >5% of blastic involvement, persistent at the time of transplantation, were included. Progression-free survival (PFS) was the primary end point, while secondary analyses focused on overall survival, relapse-free GVHD-free survival, and cumulative incidences of relapse, nonrelapse mortality, and GVHD. Results. This retrospective study reports the outcome of 56 patients receiving HSCT for de novo or secondary AML. The median age at transplantation was 56 years. The median of medullar blastic burden was 13%. Half of the cohort underwent a myeloablative conditioning regimen, while 29% of the patients received a sequential regimen approach. The median follow-up was 54,1 months, and the PFS at 1 year was 21,4% (median 98 days). Age over 60 years and unrelated matched donor were factors associated with poor PFS in our study. Overall survival was 25% at 1 year. Fifty-five percent developed aGVHD while 28,6% were reported for cGVHD. HSCT resulted in refractory disease for 24% patients, relapse incidence was 62,7% and was responsible for 53% of the whole cohort mortality. Nonrelapse mortality at one year was 32% in our study. Discussion. The important incidence of relapse in our study shows the urgent need in improvement of evolutive AML patients’ care. The main leads reported in larger trials are early donor identification, the use of sequential conditioning regimen, early tapering of immunosuppression and post-transplantation relapse prophylaxis. These findings lead to a local program in Auvergne-Rhone-Alpes region, developed in order to improve these high-risk patients’ outcome.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02420809
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Submitted on : Friday, December 20, 2019 - 10:19:43 AM
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Paul Deschamps. Allogreffe de cellules souches hématopoïétiques dans la leucémie aiguë myéloïde évolutive de l’adulte : analyse rétrospective de l’expérience grenobloise. Médecine humaine et pathologie. 2019. ⟨dumas-02420809⟩

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